Open AccessCoronary microvascular dysfunction in diabetes mellitus: A review
Author(s) -
Andrea Picchi,
Stefano Capobianco,
Tianyi Qiu,
Marta Focardi,
Xiaoqin Zou,
Ji-Min Cao,
Cuihua Zhang
Publication year - 2010
Publication title -
world journal of cardiology
Language(s) - Uncategorized
Resource type - Journals
ISSN - 1949-8462
DOI - 10.4330/wjc.v2.i11.377
Subject(s) - medicine , diabetes mellitus , diabetic cardiomyopathy , insulin resistance , endothelial dysfunction , coronary artery disease , inflammation , cardiology , polyol pathway , disease , oxidative stress , advanced glycation end product , heart failure , glycation , bioinformatics , cardiomyopathy , endocrinology , aldose reductase , biology
The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years. Cardiac function is compromised in diabetes. Diabetic patients manifest accelerated atherosclerosis in coronary arteries. These data are confirmed in diabetic animal models, where lesions of small coronary arteries have been described. These concepts are epitomized in the classic microvascular complications of diabetes, i.e. blindness, kidney failure and distal dry gangrene. Most importantly, accumulating data indicate that insights gained from the link between inflammation and diabetes can yield predictive and prognostic information of considerable clinical utility. This review summarizes the evidence for the predisposing factors and the mechanisms involved in diabetes, and assesses the current state of knowledge regarding the triggers for inflammation in this disease. We evaluate the roles of hyperglycemia, oxidative stress, polyol pathway, protein kinase C, advanced glycation end products, insulin resistance, peroxisome proliferator-activated receptor-γ, inflammation, and diabetic cardiomyopathy as a "stem cell disease". Furthermore, we discuss the mechanisms responsible for impaired coronary arteriole function. Finally, we consider how new insights in diabetes may provide innovative therapeutic strategies.