Atherosclerosis in diabetes: The role of hyperinsulinemia

摘要: Non-insulin-dependent diabetes (NIDDM) is a major cause of premature morbidity and mortality among adults. Macrovascular disease coronary peripheral vessels the primary death in these patients. Numerous experimental epidemiologic studies have suggested that hyperinsulinemia accelerates development atherosclerosis. In models, insulin promotes diet-induced lesion overrides regression estrogen protection against Local induced by selected arterial infusion atherosclerosis perfused artery. Insulin has been shown to stimulate subintimal smooth muscle fibroblast cells culture, increase uptake local synthesis lipid cells. may also induce inhibition fibrinolysis. Several prospective performed on nondiabetic patients show either fasting or postprandial levels are sensitive predictor independent other risk factors. Two recent NIDDM confirm this finding suggest glycemic control not be significant factor macrovascular disease. Diseases carbohydrate tolerance, ie, NIDDM, impaired glucose obesity, frequently associated with elevated circulating levels, physiologically secondary treatment. Given high prevalence cardiovascular populations, modifying therapy minimize should an important consideration treatment program. Use oral agents such as glipizide gliclazide, which less diurnal hyperinsulinemia, advantageous when compared traditional agent therapy.