Inflammation, insulin resistance, infection, diabetes, and atherosclerosis.

OBJECTIVE

To review the relationship between poor control of blood glucose in patients with diabetes and potential for occurrence of the acute coronary syndrome.

METHODS

The role of advanced glycosylated end products in endothelial dysfunction is discussed, and the possible contributions of inflammation and infection in the rupture of atheromatous plaques are described.

RESULTS

Hyperglycemia predisposes to infection by decreasing the efficacy of leukocytes and allowing increased formation of advanced glycosylated end products. The associated endothelial permeability facilitates bacterial infiltration of atheromatous plaques. Reported associations between chronic infection and coronary artery disease have involved primarily Chlamydia pneumoniae. The insulin resistance syndrome is also characterized by compromised endothelial function, which may predispose patients to unstable plaques and cardiac events.

CONCLUSION

In patients with diabetes, poor glycemic control may lead to excessive advanced glycosylated end products, inflammation and infection of atheromatous plaques, and plaque rupture that can cause angina or myocardial infarction.