Insulin resistance is associated with subclinical vascular disease in humans

Abstract

Insulin resistance is associated with subclinical vascular disease that is not justified by conventional cardiovascular risk factors, such as smoking or hypercholesterolemia. Vascular injury associated to insulin resistance involves functional and structural damage to the arterial wall that includes impaired vasodilation in response to chemical mediators, reduced distensibility of the arterial wall (arterial stiffness), vascular calcification, and increased thickness of the arterial wall. Vascular dysfunction associated to insulin resistance is present in asymptomatic subjects and predisposes to cardiovascular diseases, such as heart failure, ischemic heart disease, stroke, and peripheral vascular disease. Structural and functional vascular disease associated to insulin resistance is highly predictive of cardiovascular morbidity and mortality. Its pathogenic mechanisms remain undefined. Prospective studies have demonstrated that animal protein consumption increases the risk of developing cardiovascular disease and predisposes to type 2 diabetes (T2D) whereas vegetable protein intake has the opposite effect. Vascular disease linked to insulin resistance begins to occur early in life. Children and adolescents with insulin resistance show an injured arterial system compared with youth free of insulin resistance, suggesting that insulin resistance plays a crucial role in the development of initial vascular damage. Prevention of the vascular dysfunction related to insulin resistance should begin early in life. Before the clinical onset of T2D, asymptomatic subjects endure a long period of time characterized by insulin resistance. Latent vascular dysfunction begins to develop during this phase, so that patients with T2D are at increased cardiovascular risk long before the diagnosis of the disease.

Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome

“…Moreover, IR accompanied by hyperglycaemia and hypertriglyceridaemia has been demonstrated to be correlated with elevated plasminogen activator inhibitor-1 levels, leading to decreased fibrinolytic activity and increased thrombotic events [28,29]. Furthermore, IR has been shown to be associated with structural and functional arterial wall injuries, such as endothelial dysfunction, impaired vasodilation, increased arterial stiffness, increased intima-media thickness, and increased coronary artery calcification, which are highly predictive of future CV events [30]. Notably, several studies confirmed [31].…”

Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes

“…An independent association was reported between insulin resistance (assessed by HOMA-IR) and cardiovascular events both in subjects with and without diabetes [ 8 – 10 ]. In addition, several studies provide compelling evidence of an association between insulin resistance and subclinical vascular injury involving functional and structural damage to the arterial wall that is not explained by traditional risk factors [ 11 ]. Early atherosclerosis detected by intima-media thickness is also independently associated with insulin resistance in patients with type 2 diabetes [ 12 ].…”

Vascular Remodeling Markers in Patients with Essential Arterial Hypertension Depending on Presence of Type 2 Diabetes Mellitus

“…Ряд исследований показал, что наличие СД 2 типа у пациентов с АГ значительно усугубляет процессы сосудистого ремоделирования. При этом гипергликемия и инсулинорезистентность тканей являются основными триггерами патогенетических процессов, которые усугубляют артериальную жесткость и повышают восприимчивость сосудистой стенки к развитию атеросклероза [13].…”