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Insulin resistance, inflammation, and the prediabetic state
1Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA. haffner@uthscsa.edu
The American Journal of Cardiology
|September 6, 2003
Summary
Prediabetes, characterized by insulin resistance, contributes to coronary artery disease (CAD) risk through elevated triglycerides, blood pressure, and inflammation. Early detection and insulin-sensitizing treatments may mitigate these risks in type 2 diabetes patients.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Metabolic Syndrome
Background:
- Type 2 diabetes significantly increases coronary artery disease (CAD) risk, yet glycemia shows a weak correlation with CAD in these patients.
- An atherogenic prediabetic state, marked by insulin resistance, may explain the modest link between glycemia and CAD.
- Prediabetic changes include elevated triglycerides, systolic blood pressure, and reduced high-density lipoprotein cholesterol.
Purpose of the Study:
- To investigate the relationship between prediabetes, insulin resistance, and the development of cardiovascular risk factors.
- To explore the role of subclinical inflammation and fibrinolysis in the progression from prediabetes to type 2 diabetes.
- To assess the impact of insulin-sensitizing interventions on these nontraditional risk factors.
Main Methods:
- Analysis of data from studies like the San Antonio Heart Study and the Insulin Resistance Atherosclerosis Study.
- Assessment of metabolic parameters including glucose tolerance, triglyceride levels, blood pressure, and high-density lipoprotein cholesterol.
- Evaluation of inflammatory markers such as high-sensitivity C-reactive protein (CRP) and fibrinolysis markers like plasminogen activator inhibitor-1 (PAI-1).
Main Results:
- Insulin resistance is linked to higher CRP, fibrinogen, and PAI-1 levels.
- Elevated PAI-1 and CRP levels predict the development of type 2 diabetes.
- Insulin-sensitizing interventions, like rosiglitazone, can reduce PAI-1 and CRP levels, potentially reversing adverse cardiovascular effects.
Conclusions:
- Insulin resistance, rather than solely reduced insulin secretion, underlies atherogenic changes in prediabetes.
- Subclinical inflammation and impaired fibrinolysis are key components of the prediabetic state and predictors of type 2 diabetes.
- Insulin-sensitizing agents show promise in managing cardiovascular risk factors associated with type 2 diabetes and prediabetes.
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