Subclinical atherosclerosis and chronic troponin elevation: the voice of silence in diabetics.

Downloa with renal impairment; in this context, AGEs may provide the common pathophysiological link. An increase in AGEs can be determined fundamentally by 2 factors: the existence of chronic hyperglycemia and/or a high degree of oxidative stress (3). Although AGEs occur as a result of hyperglycemia, their effects can occur independently of glycemic control. This finding may explain the paradoxical progression of diabetic complications in some patients with comparatively good glycemic control. Results from the DCCT are consistent with the hypothesis that other factors such as oxidative stress may be more important mediators of advanced glycation than hyperglycemia per se in patients already receiving interventions directed at improving glycemic control. We introduce the question of whether the relationship between HbA1c and hs-cTnT is primary or is mediated by AGEs. Perhaps it would be necessary to conduct a multivariate analysis to consider whether HbA1c levels predict silent coronary disease regardless of the levels of AGEs.