The insulin resistance syndrome: impact on lipoprotein metabolism and atherothrombosis

insulin resistance is a common metabolic abnormality that is associated wit h an increased risk of both atherosclerosis and type 2 diabetes. The phenot ype of insulin resistance includes a dyslipidemia characterized by an eleva tion of very low-density lipoprotein triglyceride, a reduction in high-dens ity lipoprotein cholesterol, and the presence of small, triglyceride-enrich ed low-density lipoproteins. The underlying metabolic abnormality driving t his dylipidemia is an increased assembly and secretion of very low-density lipoprotein particles, leading to an increased plasma level of triglyceride . Hypertriglyceridemia, in turn, results in a reduction in the high-density lipoprotein level and the generation of small, dense low-density lipoprote ins; these events are mediated by cholesteryl ester transfer protein. In ad dition, hypertension, obesity, and a prothrombotic state are also integral components of the insulin resistance syndrome. In this review, we will prov ide a pathophysiologic basis, based on studies on humans and in tissue cult ure, for the dyslipidemia of insulin resistance. We will also review the ef fects of insulin resistance on the coagulation and fibrinolytic pathways. I t is hoped that this review will allow health professionals better to evalu ate and treat their patients with insulin resistance, thereby reducing the very much increased risk of atherosclerotic cardiovascular disease carried by these individuals. (C) 2000 Lippincott Williams & Wilkins.