Insulin resistance and cardiovascular disease

The article was written by Cardiologists and Interventional Cardiologists, Cardiology Center - Vinmec Central Park International General Hospital

Insulin resistance can be defined as a decrease in the response of tissues and cells to insulin stimulation. Thus, insulin resistance is characterized by impaired glucose uptake and impaired glucose utilization (for glucose oxidation for energy) in the cell. When there is insulin resistance, the pancreas must increase the release of insulin into the blood, increasing the concentration of insulin in the blood.

Obesity Stress (leading to excessive elevation of certain hormones such as cortisol, growth hormone, catecholamines, glucagon ...) Medicines (such as glucocorticoids, HIV antiviral drugs, oral contraceptives) Pregnancy Lipodystrophy Resistance insulin resistance (In patients treated with insulin for diabetes) Hereditary disease affecting insulin receptors

Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), type 2 diabetes, increased insulin requirements in patients with type 1 diabetes Coronary artery disease Metabolic syndrome Ovarian syndrome polycystic eggs Nonalcoholic fatty liver disease Some cancers are linked to obesity (such as endometrial cancer) Acanthosis nigricans: the appearance of thick, horny patches on the skin, smooth, brown color usually on the back of the neck, armpits, groin, and above the elbows. Besides elevated LDL cholesterol, smoking, hypertension, type 1 and type 2 diabetes are important risk factors for cardiovascular disease - insulin resistance, hyperglycemia, inflammation can lead to to cardiovascular events.
First, insulin resistance leads to hyperglycemia and diabetes. Persistent hyperglycemia adversely affects endothelial cells and cardiac muscle cells. In patients with type 2 diabetes, the risk of cardiovascular disease is increased 2 to 8 times compared with those without diabetes.
Insulin resistance can lead to dyslipidemia. Dyslipidemia associated with insulin resistance is characterized by a triad: 1/ increased triglyceride levels. 2/ reduce HDL - cholesterol (the good kind). 3/ Increases the fraction of small and dense LDL. Elevated triglycerides increase the risk of heart disease in men by 32% and 76% in women.

In clinical studies it has been demonstrated that approximately 50% of hypertensive patients have hyperinsulinemia (associated with insulin resistance). There is a strong association between insulin resistance, hyperglycemia and hypertension.
Insulin resistance contributes to vascular endothelial cell dysfunction leading to reduced levels of Nitric Oxide (NO), which is considered an endogenous vasodilator. Vascular endothelial cell dysfunction increases the risk of cardiovascular disease including hypertension, atherosclerosis, and coronary artery disease.
Insulin resistance has an adverse effect on cardiomyocyte metabolism, myocardial contractility leading to ventricular hypertrophy and ventricular diastolic dysfunction and ultimately to heart failure.
In summary, insulin resistance by direct (vascular endothelial, myocardial) or indirect (hyperglycemia, dyslipidemia, or hypertension ...) increases cardiac pathology. circuit. Therefore, early recognition and treatment of this syndrome helps to prevent early cardiovascular disease and its complications.

Diagnosis of insulin resistance syndrome associated with obesity is based on markers of metabolic syndrome. To diagnose metabolic syndrome requires at least 3 of the following signs:
Abdominal obesity: Abdominal circumference greater than 89cm in women and greater than 102cm in men. 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) women Hypertension: blood pressure greater than or equal to 130/85 mmHg Fasting blood glucose: greater than 100 mg/dL (5.6 mmol/L) Certain tests such as intravenous glucose tolerance test, tolerance test insulin, insulin suppression testing is considered the gold standard for the diagnosis of insulin resistance, but these techniques are not routinely used in clinical practice.

When insulin resistance syndrome is diagnosed, it is important to make healthy lifestyle adjustments to prevent important complications such as heart attack or stroke. A healthy lifestyle includes:
Regular physical activity : According to health experts, it is only necessary to get at least 30 minutes of physical activity a day such as brisk walking. In daily activities, it is necessary to create opportunities for physical activity, such as choosing to walk instead of riding, 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. In cases where weight cannot be controlled, it is necessary to consult a doctor, sometimes additional medication or surgery is necessary to achieve the goal of weight loss. Diet: A healthy diet includes vegetables, fruits, nuts, and seeds that are high in fiber and pure protein. Limit alcohol, beer, foods high in sugar, salt, and fat (especially saturated fat). Smoking cessation: Smoking cessation to improve general health, in many situations requires additional smoking cessation products. Reduce or manage stress: Physical activity, yoga, and medication can help manage stress and improve mental and physical health.

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