HYPERINSULINEMIA AND ATHEROSCLEROSIS

Studies of macrovascular disease in non-insulin-dependent diabetes (NI DDM) have shown a significant increase in peripheral vascular, coronar y, and carotid artery disease in diabetics compared to non-diabetics. This prevalence appears to be related to insulin levels and to the deg ree of hyperinsulinemia as measured in the blood of these patients. In deed, a cluster of markers, including hyperinsulinemia, insulin resist ance, hypertension, dyslipoproteinemia, and a high waist-hip ratio, ha s been associated with NIDDM and increased risk for macrovascular dise ase. Variously described as Metabolic Syndrome or Syndrome X, this syn drome may be operative for many years before NIDDM is diagnosed. Given the complexity of Metabolic Syndrome, a single-factor intervention fo r preventing macrovascular disease in NIDDM is unlikely. However, it s eems advisable to screen, on a regular basis, all patients presenting a pre-NIDDM state, as well as those with overt NIDDM, for pertinent ca rdiovascular risk parameters and for emerging macrovascular disease. I t is suggested that any attempt to prevent macrovascular disease in su bjects with glucose intolerance should aim at decreasing insulin resis tance and hyperinsulinemia.