Impact of glycemic variability on coronary and peripheral endothelial dysfunction in patients with coronary artery disease
Open accessAbstract
Background Previous studies have reported that glucose variability leads to endothelial dysfunction and progression of coronary atherosclerosis. However, few studies have directly evaluated the relation between glucose variability and coronary endothelial function in patients with coronary artery disease (CAD).Methods A total of 38 patients with chronic CAD and a history of coronary drug-eluting stent implantation were enroled. Coronary endothelial function was evaluated by measuring the coronary vasoreactivity using quantitative coronary angiography in the segment distal to implanted stent in response to intracoronary acetylcholine (ACh) infusion (10-7 mol/l). Peripheral endothelial function was also assessed with reactive hyperemia index (RHI). The mean amplitude of glycemic excursion (MAGE) was calculated as a primary metric of glucose variability using a flash glucose monitoring system.Results Of 38 patients, 17 (45%) had diabetes mellitus. The mean levels of glycated hemoglobin, MAGE, and RHI were 6.3 ± 0.8%, 71.4 ± 29.8 mg/dl, and 1.85 ± 0.63. In the distal segment to coronary stent, lumen diameter was constricted by 0.6 ± 7.3% in response to intracoronary ACh infusion compared to that at baseline. While peripheral endothelial function assessed with RHI was not significantly associated with MAGE (r = -0.16, p = 0.35), coronary endothelial function was correlated with MAGE (r = -0.38, p = 0.02).Conclusion Greater glucose variability was significantly associated with coronary rather than peripheral endothelial dysfunction in patients with CAD, suggesting an impact of glucose variability on coronary atherosclerosis.
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Glycemic variability is linked to oxidative stress, endothelial dysfunction, and cardiovascular outcomes independent of mean glucose levels.
“new literature evidence links glycemic variability to oxidative stress, endothelial dysfunction, and cardiovascular outcomes independent of mean glucose levels [[51], [52], [53], [54]].”
From Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: A systematic review and meta-analysis (2025) · cites this paper as [52]
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- Authors
- Tateishi, K., Saito, Y., Kitahara, H., & Kobayashi, Y.
- Affiliations
- Chiba University (JP)
- Corresponding author
- Tateishi, Kazuya
- Venue
- Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 79
- Issue
- 1
- Pages
- 65-70
- ISSN
- 0914-5087 (ISSN-L)
- OpenAlex
- W3198740020
- Cited by
- 16
- References
- 47
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 2 · 2022: 4
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- glycemic variability, endothelial dysfunction, coronary endothelial function, peripheral endothelial function, coronary artery disease, mean amplitude of glycemic excursions, coronary vasoreactivity, acetylcholine, reactive hyperemia index, drug-eluting stents, diabetes mellitus, HbA1c
- MeSH terms
- Blood Glucose, Coronary Artery Disease, Endothelium, Vascular, Humans, Blood Glucose Self-Monitoring, Coronary Angiography, Drug-Eluting Stents
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