Epidemiology of insulin resistance and its relation to coronary artery disease

The relation of insulin resistance to cardiovascular risk, particularly for coronary artery disease (CAD), has been well established in many prospecti ve studies. The clustering of insulin resistance and/or hyperinsulinemia, h ypertriglyceridemia, hypertension, and low HDL is now considered a feature of the insulin resistance syndrome. However, the association is complex and the pathways by which elevated insulin adversely affects both CAD risk fac tors and the risk of developing CAD have yet to be elucidated. Postprandial lipemia may be a mechanistic link between insulin resistance and CAD, Hype rinsulinemia appears to be a weak, but positive, independent cardiovascular risk factor, The strongest relations are seen in middle-aged rather than o lder persons and at higher elevations of plasma insulin levels. Individuals with type 2 diabetes have a risk of myocardial infarction (MI) equivalent to that of nondiabetic persons who have had a previous MI. Given the relati vely weak association between duration of diabetes and severity of hypergly cemia and cardiovascular disease, common antecedents may underlie both CAD and type 2 diabetes. (C) 1999 by Excerpta Medica, Inc.