Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

Angeli, Fabio; Reboldi, Gianpaolo; Poltronieri, Cristina; Lazzari, Ludovico; Sordi, Martina; Garofoli, Marta; Bartolini, Claudia; Verdecchia, Paolo

doi:10.1177/1753944715594528

Cited by 65 publications

(59 citation statements)

References 74 publications

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“…SIH could be a vicious cycle by increasing free fatty acids, insulin resistance, chemical inactivation of nitric oxide and the production of reactive oxygen species, a prothrombotic state, and vascular inflammation20. Patients with SIH could have increased susceptibility to myocardial ischemia-reperfusion injury due to increased oxidative stress, inflammation, and activation of stress-responsive kinases21.…”

Section: Discussionmentioning

confidence: 99%

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

Lin

Lee

et al. 2016

Sci Rep

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Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

Lin

Lee

et al. 2016

Sci Rep

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“…Elevated blood glucose levels have nevertheless also been associated with impaired outcomes in acute situations such as myocardial infarction and stroke [19–21]. The mechanisms responsible may include hyperglycemia-induced release of free fat acids, the inactivation of nitric oxide (NO), and increased production of reactive oxygen species (ROS) [19], respectively. A number of studies compared glucose control in the intensive care unit by either conventional or intensified (continuously administered) insulin therapy with regard to AKI incidences.…”

Section: Blood Glucose Control At the Intensive Care Unit: Impact mentioning

confidence: 99%

Acute Kidney Injury in Diabetes Mellitus

Patschan

Müller

2016

International Journal of Nephrology

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Diabetes mellitus (DM) significantly increases the overall morbidity and mortality, particularly by elevating the cardiovascular risk. The kidneys are severely affected as well, partly as a result of intrarenal athero- and arteriosclerosis but also due to noninflammatory glomerular damage (diabetic nephropathy). DM is the most frequent cause of end-stage renal disease in our society. Acute kidney injury (AKI) remains a clinical and prognostic problem of fundamental importance since incidences have been increased in recent years while mortality has not substantially been improved. As a matter of fact, not many studies particularly addressed the topic “AKI in diabetes mellitus.” Aim of this article is to summarize AKI epidemiology and outcomes in DM and current recommendations on blood glucose control in the intensive care unit with regard to the risk for acquiring AKI, and finally several aspects related to postischemic microvasculopathy in AKI of diabetic patients shall be discussed. We intend to deal with this relevant topic, last but not least with regard to increasing incidences and prevalences of both disorders, AKI and DM.

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“…In contrast to the acute inflammatory reactions induced by bacteria and viruses, chronic inflammation can be driven by abnormal reaction to endogenous factors, including Th2 cytokines [7], metabolic factors like advanced glycation end products (AGEs) [8], modified lipoproteins [9], or hyperglycemia [10]. …”

Section: Introductionmentioning

confidence: 99%

Perspectives for Monocyte/Macrophage-Based Diagnostics of Chronic Inflammation

Kzhyshkowska¹,

Gudima

Moganti

et al. 2016

Transfus Med Hemother

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Low-grade chronic inflammation underlies the development of the most dangerous cardiometabolic disorders including type 2 diabetes and its vascular complications. In contrast to acute inflammation induced by bacteria and viruses, chronic inflammation can be driven by abnormal reaction to endogenous factors, including Th2 cytokines, metabolic factors like advanced glycation end products (AGEs), modified lipoproteins, or hyperglycemia. The key innate immune cells that recognize these factors in blood circulation are monocytes. Inflammatory programming of monocytes which migrate into tissues can, in turn, result into generation of tissue macrophages with pathological functions. Therefore, determination of the molecular and functional phenotype of circulating monocytes is a very promising diagnostic tool for the identification of hidden inflammation, which can precede the development of the pathology. Here we propose a new test system for the identification of inflammatory programming of monocytes: surface biomarkers and ex vivo functional system. We summarize the current knowledge about surface biomarkers for monocyte subsets, including CD16, CCR2, CX3CR1, CD64, stabilin-1 and CD36, and their association with inflammatory human disorders. Furthermore, we present the design of an ex vivo monocyte-based test system with minimal set of parameters as a potential diagnostic tool for the identification of personalized inflammatory responses.

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Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

Cited by 65 publications

References 74 publications

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

Acute Kidney Injury in Diabetes Mellitus

Perspectives for Monocyte/Macrophage-Based Diagnostics of Chronic Inflammation

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