Atherosclerosis: an insulin-dependent disease?

Evidence is reviewed that dietary habits in industrially developed countries, especially an increased frequency of ingestion of foods of high energy density, may contribute to excessive hepatic cholesterol synthesis and to a preponderance of lipogenic versus lipolytic effects on the arterial intima, thereby favoring the formation and progression of atheroma. These effects are mediated by the rise and fall of circulating insulin levels. The evidence is suggestive of the possibility that frequent and prolonged exposure of the arterial wall to high circulating levels of insulin may favor the development of atherosclerotic lesions. Research on diet-atherosclerosis relationships should take into account not only overall diet composition but individual meal composition and size and their effects on serum insulin levels, as well as meal spacing and the relative durations of absorptive and postabsorptive periods during the 24-hour daily cycle.