Impaired postprandial tissue regulation of blood flow in insulin resistance: a determinant of cardiovascular risk?

The insulin resistant state is a major risk factor for coronary artery dise ase. This increased risk is likely to be due to associated lipid and coagul ation abnormalities rather than just abnormalities in glucose metabolism or hyperinsulinaemia alone. Exaggerated postprandial lipaemia is a well-recog nised associate of insulin resistance and postprandial hypertriglyceridaemi a is particularly important in the development of coronary atheroma. It see ms likely that insulin is one of the hormonal regulators of adipose tissue and skeletal muscle blood flow. The reduced blood fl ow and blunting of the postprandial rise of peripheral blood flow in insulin resistance may decre ase chylomicron-triglyceride delivery to muscle in subjects with insulin re sistance. This, in turn, will lead to increased production of atherogenic p articles. We propose that impaired postprandial vasodilation, already recog nised as a key feature of glucose intolerance, is also the cause of impaire d lipid metabolism in insulin resistant subjects and predisposes them to ca rdiovascular disease. (C) 1999 Elsevier Science Ireland Ltd. All rights res erved.