Mechanisms of Acute Coronary Syndromes

To the Editor: In his review article about the mechanisms of disease of acute coronary syndromes and their potential therapies, Libby (May 23 issue)(1) does not refer to the role of hyperglycemia, although the association between dysglycemia and atherosclerosis has been clearly shown.(2) Hyperglycemia is an important factor in cardiovascular damage, working through different mechanisms such as the activation of protein kinase C, polyol and hexosamine pathways, and the production of advanced glycation end products.(3) Moreover, hyperinsulinism has been established as an important factor associated with the occurrence of new cardiovascular events in patients with a first myocardial infarction.(4) The ...