Endothelial dysfunction is an early stage of atherosclerosis and has been attributed to impaired nitric oxide (NO) bioactivity and enhanced formation of oxygen-derived free radicals. Given that endothelial dysfunction is at least in part reversible, the assessment of altered NO availability is of important diagnostic and prognostic significance. Identification of such alterations may help to target asymptomatic individuals who are at risk for cardiovascular diseases and would likely benefit from preventive measures. Focusing on a single signaling pathway, we present here a multi-level approach for the early diagnosis of cardiovascular diseases by assessing molecular, biochemical, structural, and functional changes in the vascular wall.