Mechanism by which hyperglycemia plays a role in the setting of acute cardiovascular illness.
Acute hyperglycemia is associated with excess morbidity and mortality in acute cardiovascular illness in both diabetic and nondiabetic patients. Hyperglycemia is associated with altered myocardial energetics, but abnormalities in glucose oxidation and glycolysis do not fully account for this excess risk. Hyperglycemia leads to a pro-oxidative/proinflammatory state that is associated with endothelial dysfunction, diminished coronary vasodilatory reserve, and a prothrombotic state. Hyperglycemia negates the protective effect of ischemic preconditioning and, most importantly, appears to interfere with the salutary effects of insulin in acute cardiovascular illness. Aggressive therapy with continuous infusion of insulin seems to improve a host of metabolic and physiologic effects associated with acute hyperglycemia and appears warranted if euglycemia can be maintained.
Zarich
Stuart W
SW
Division of Cardiovascular Medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA.
D000208:Acute Disease; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D002983:Clinical Competence; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality; D005947:Glucose / Q000009:adverse effects; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D018836:Inflammation Mediators / Q000378:metabolism; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D018384:Oxidative Stress; D018579:Patient Selection; D011188:Potassium / Q000009:adverse effects
D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D018836:Inflammation Mediators; D007328:Insulin; D011188:Potassium; C030396:glucose-insulin-potassium cardioplegic solution; C517652:hemoglobin A1c protein, human