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Excessive vascular smooth muscle and macrophage proliferation underlies impaired coronary collateral growth in the metabolic syndrome

Coronary collateral growth (CCG) is impaired in the metabolic syndrome. It is thought that inadequate cell proliferation is a causative factor. Pro‐angiogenic growth factors (GFs) stimulate cell proliferation. Metabolic syndrome patients and animal models exhibit elevated GF levels, but administration of GFs does not promote CCG in the metabolic syndrome.