Glycated Proteins and Cardiovascular Disease in Glucose Intolerance and Type 2 Diabetes

Individuals with diabetes have more atherosclerosis and cardiovascular events and a higher complication rate from cardiovascular events than nondiabetic individuals. Also, lesions from diabetic patients are more prone to rupture and exhibit more intravascular thrombosis than those from nondiabetic patients. Glucose modification of circulating proteins and matrix proteins mediates the activation of the inflammatory pathways critical in diabetes-associated atherosclerosis. Extracellular matrix proteins containing advanced glycation end products (AGEs) serve as ligands for scavenger receptors and the receptor for AGEs. Ligation of the receptor for AGEs activates inflammatory pathways and destabilizes atherosclerotic plaques in diabetic patients. Clinically, researchers have used concentrations of fructosamine and glycosylated hemoglobin to investigate the relationships among glycemia, glucose-modified proteins, and cardiovascular risk. They found that increased levels of fructosamine and hemoglobin A 1c are associated with a significantly increased multivariable-adjusted risk of cardiovascular events.