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©2010 Baishideng Publishing Group Co., Limited. All rights reserved.
Coronary microvascular dysfunction in diabetes mellitus: A review
Andrea Picchi, Stefano Capobianco, Tianyi Qiu, Marta Focardi, Xiaoqin Zou, Ji-Min Cao, Cuihua Zhang
Andrea Picchi, Marta Focardi, Ji-Min Cao, Department of Cardiology, Misericordia Hospital, Via Senese 161, 58100 Grosseto, Italy
Stefano Capobianco, Ji-Min Cao, Department of Cardiology, Gaetano Rummo Hospital, Via Dell'Angelo 1, 82100 Benevento, Italy
Tianyi Qiu, Cuihua Zhang, Department of Internal Medicine, Medical Physiology and Pharmacology, Nutrition and Exercise Physiology, Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO 65211, United States
Xiaoqin Zou, Department of Physics, Department of Biochemistry, Dalton Cardiovascular Research Center, and Informatics Institute, University of Missouri-Columbia, MO 65211, United States
Ji-Min Cao, Department of Physiology, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100005, China
Author contributions: Picchi A and Capobianco S contributed equally to this work; Qiu T, Focardi M, Zou X, Cao JM and Zhang C were involved in writing the manuscript.
Supported by Grants from Pfizer Atorvastatin Research Award, No. 2004-37; American Heart Association SDG, No. 110350047A; and NIH Grants, No. RO1 HL077566 and RO1 HL085119 to Zhang C
Correspondence to: Cuihua Zhang, MD, PhD, Department of Internal Medicine, Medical Pharmacology and Physiology and Nutrition and Exercise Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, United States. zhangcu@missouri.edu
Telephone: +1-573-8822427 Fax: +1-573-8844232
Received: August 2, 2010
Revised: September 19, 2010
Accepted: September 26, 2010
Published online: November 26, 2010
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.
