Insulin resistance and cardiovascular disease

Article written by Interventional Cardiologist and Cardiologist, Cardiovascular Center – Share99 Central Park International Health Hub

Insulin resistance can be defined as a decrease in the response of tissues and cells to the stimulation of insulin. Therefore insulin resistance is characterized by a decrease in glucose collection and defects in the use of glucose (for the oxidation of glucose to generate energy) in the cell. When there is insulin resistance the pancreas must increase the release of insulin into the bloodstream, which increases the concentration of insulin in the blood.

• obesity
• Stress (leading to an excessive increase in certain hormones such as cortisol, growth hormone, catecholamine, glucagon …)
• Medications (such as glucocorticoids, HIV antiviral drugs, oral contraceptives)
• Pregnancy
• Fat dysersm
• Anti-insulin antibodies (In patients treating diabetes with insulin)
• Genetic diseases that affect insulin receptors

• Glucose tolerance disorder (IGT), hunger blood glucose disorder (IFG), type 2 diabetes mellitus, increased demand for insulin in patients with type 1 diabetes mellitus
• Coronary artery disease
• Conversion syndrome
• Polycystic Ovary Syndrome
• Non-alcoholic fatty liver disease
• Some cancers are associated with obesity (such as endometrial cancer)
• Black thorns (Acanthosis nigricans): appear in the skin of thick, brown, smooth patches usually on the back of the neck, armpits, groin, and above the elbows.

Besides increased LDL – cholesterol, smoking, hypertension, diabetes mellitus type 1 and type 2 are important risk factors for cardiovascular disease – insulin resistance, hypoglycemia , inflammation can lead to cardiovascular events.

Insulin resistance first leads to hypertension and diabetes mellitus. Persistent hypertension adversely affects vascular endometriosis and myocardial cells. In patients with type 2 diabetes mellitus the risk of cardiovascular disease increases by 2-8 times compared to people without diabetes mellitus.

Insulin resistance can lead to dyslipidemia. Dyslipidemia associated with insulin resistance characterized by triglycerides: 1/ increased triglyceride levels. 2 / reduce HDL – cholesterol (good type). 3/ increase the small and dense LDL composition. Increasing triglycerides increases the risk of heart disease in men by 32% and 76% in women.

In clinical studies it is proven that about 50% of patients with hypertension have an increase in blood insulin (which is associated with insulin resistance). There is a strong link between insulin resistance, hypertension and hypertension.

Insulin resistance contributes to vascular endal cell dysfunction resulting in a decrease in the amount of Nitric Oxide (NO) considered an end enderthistial vascular stretcher. Vascular endal cell dysfunction increases cardiovascular disease including hypertension, atherosclerosis and coronary artery disease.

Insulin resistance has a negative effect on the transformation of myocardial cells, myocardial contraction leads to atrocular hypertrocgestion and atacugal dysfunction and eventually leads to heart failure.

In summary, direct insulin resistance (endocardial effects of blood vessels, myocardium) or indirectly(hypertensiveemia, dyslipidemia, or hypertension…) increases cardiovascular pathology. So early recognition and treatment of this syndrome helps to prevent early cardiovascular pathology and its complications.

Diagnosis of insulin resistance syndrome is associated with obesity based on signs of conversion syndrome. To diagnose the syndrome of conversion it is necessary to have at least 3 of the following signs:

• Abdominal fat: The abdominal ring is larger than 89cm in females and larger than 102cm in males.
• Increased blood triglyceride levels: greater than 150 mg/dL ( 1.7 mmol/L)
• DECREASED HDL – cholesterol: less than 40 mg/dL (1.04 mmol/L) in men or less than 40 mg/dL (1.3 mmol/L) in women
• Hypertension : bloodpressure greater than or equal to 130/85 mmHg
• Hypertension : greater than100 mg/dL (5.6 mmol/L)

Some tests such as intravenous glucose tolerance tests, insulin tolerance tests, insulin suppression tests are considered the gold standard for diagnosing insulin resistance, but these techniques are not routinely used clinically.

When there is a diagnosis of insulin resistance syndrome it is necessary to adjust a healthy lifestyle to prevent important complications such as a myocardial infarction or stroke. A healthy lifestyle includes:

• Regular physical activity: Accordingto medical experts, it is only necessary to achieve at least 30 minutes of physical activity every day such as walking fast. In daily life, it is necessary to create opportunities for physical activity, such as choosing to walk instead of driving, or take the stairs instead of using the elevator.
• Weight loss:Losing 7 – 10% of body weight reduces insulin resistance, blood pressure, and the risk of diabetes mellitus. In case of uncontrollable weight, it is necessary to see a doctor, sometimes it is necessary to use additional medications or surgeries to achieve the purpose of weight loss.
• Diet : Ahealthy diet consisting of vegetables, fruits, nuts high in fiber, pure protein. Limit the intake of alcohol, beer, foods high in sugar, salt, fats (especially saturated fats).
• Stop smoking:Stop smoking to improve general health, in many situations additional smoking cessation products are required.
• Reduce or control stress: Physical activity, yoga, medicine can help control stress and improve mental health and fitness.

In case of adjusting the lifestyle with diet and exercise but not reaching the goal, it is necessary to see a doctor for additional medications that control blood pressure, blood cholesterol levels, and blood glucose levels.

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