Insulin resistance and hyperinsulinemia as risk factors in cardiovascular disease

Insulin resistance is defined as a metabolic state in which insulin peripheral effects are diminished. This condition is compensated by an insulin secretion increase called "compensatory hyperinsulinemia". Several years ago several authors are agree with the fact that insulin resistance and hiperinsulinemia are involved in hypertension, obesity and diabetes. Equally, hyperinsulinemia is related with a plasmatic lipidic pattern characterized by a decrease in HDL cholesterol and increases in triglyceride and VLDL levels that in turn conduces to atherosclerosis development. In this sense, myocardial ischemia has been related with these conditions in both, genesis and further evolution because accelerated atherosclerosis and myocyte survival reduction by angiogenesis blockade at insulin-signalling level. Hyperinsulinemia is related with myocardial hypertrophy. One hypothesis that has been designed to explain this association is that insulin may directly increase blood pressure and therefore left ventricular work. In support of this, insulin has been shown to activate the sympathetic nervous system in patients with essential hypertension. Finally, impaired insulin sensitivity is highly prevalent among non-diabetic patients with a recent TIA or non-disabling ischemic stroke. This finding has important therapeutic implications if treatment to improve insulin sensitivity is shown to reduce risk for subsequent stroke and heart disease.