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.

Keywords: Diabetes, Cardiovascular risk, Arterial stiffness, Arterial elasticity, Intima-media thickness, Vascular calcification, Insulin resistance, Animal protein, Vegetable protein

Core tip: Vascular injury associated to insulin resistance 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.