Atherogenesis and Diabetes: Focus on Insulin Resistance and Hyperinsulinemia Aterogénesis y diabetes: resistencia a la insulina e hiperinsulinemia

Macroand microvascular complications are both main causes of morbidity and mortality in type 1 and type 2 diabetes, but macrovascular complications have an increased incidence even before the onset of type 2 diabetes. While high blood glucose and glucose-induced protein and lipid modifications—the advanced glycation endproducts—can be triggers of both macroand microvascular disease once diabetes (both type 1 and type 2) has occurred, factors causing macrovascular disease in the setting of the metabolic syndrome and prediabetes have long been debated. Certainly in diabetes, and probably also in the setting of the metabolic syndrome, atherosclerotic vascular and coronary heart disease occur over and above the clustering of other accompanying risk factors, such as hypertriglyceridemia, low levels of high-density lipoproteins and hypertension. Insulin resistance before the onset of diabetes is, by definition, characterized by hyperinsulinemia, and this has long been speculated to be causally linked to vascular disease. In this brief review we will address the biological plausibility and the evidence for hyperinsulinemia to be a causal mechanism in the development of atherosclerosis preceding and following the onset of type 2 diabetes.