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Therapy Insight: heart disease and the insulin-resistant patient

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 252–260 (2005)Cite this article

Abstract

Insulin-resistance syndromes are of pandemic proportions; 150 million people worldwide and an estimated 43 million people in the US are currently affected by type 2 diabetes mellitus or metabolic syndrome respectively. Treatment of heart disease in the context of type 2 diabetes requires multifactorial risk-factor management, including lifestyle modification and drug treatment for comorbidities. Management of coronary risk extends beyond simple cholesterol lowering. Early use of cardiac imaging and, where appropriate, revascularization should be considered in high-risk or symptomatic patients. Traditionally, patients with type 2 diabetes and coronary arterial disease have been treated surgically, but percutaneous revascularization of these patients is increasingly common. Indeed, revascularization by use of drug-eluting coronary stents combined with administration of novel antiplatelet agents has revolutionized percutaneous coronary intervention in patients with type 2 diabetes. Despite these advances, there is no consensus of opinion regarding revascularization strategies or risk-factor management in insulin-resistant patients with symptomatic or prognostically important coronary arterial disease. Furthermore, specific therapies and preventative strategies for diabetic cardiomyopathy and heart failure in patients with type 2 diabetes remain elusive. The identification of optimized approaches for the prevention and treatment of the metabolic syndrome and heart disease in insulin-resistant, nondiabetic patients remains a major global challenge.

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Figure 1: Cellular mechanisms of insulin resistance.

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Acknowledgements

The authors are supported by grants from the UK Department of Health, the Medical Research Council, the Wellcome Trust and the British Heart Foundation.

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Authors and Affiliations

  1. Lecturer in Clinical Cardiology at the Imperial College Faculty of Medicine, London, UK

    Stuart A Cook

  2. Professor of Clinical & Molecular Genetics at the Imperial College Faculty of Medicine, Section Chair at the Medical Research Council Clinical Sciences Centre and an honorary Consultant Physician at Hammersmith Hospital, London, UK

    Tim Aitman

  3. Senior Clinical Scientist at the Medical Research Council Clinical Sciences Centre and honorary Consultant Physician at Hammersmith Hospital, London, UK

    Rossi P Naoumova

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Correspondence to Stuart A Cook.

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Glossary

EUGLYCEMIC CLAMP TECHNIQUE

Insulin is infused at a constant rate and glucose titrated to a preset level. Insulin resistance is measured when a steady state is reached

HOMEOSTATIC MODEL ASSESSMENT

Uses fasting blood levels of insulin and glucose to model insulin resistance and β-cell function

MINIMAL MODEL ANALYSIS

Profiles of insulin and glucose concentrations after an intravenous glucose bolus are used to estimate insulin resistance and β-cell function by curve fitting

ORAL GLUCOSE TOLERANCE TEST

Plasma glucose levels are measured after oral consumption of 75 g anhydrous glucose in 250–300 ml of water. Raised glucose levels indicate impaired glucose tolerance

ADIPOKINES

Small proteins secreted from adipocytes which act on peripheral tissues to induce receptor-mediated activation of cellular signaling

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Cook, S., Aitman, T. & Naoumova, R. Therapy Insight: heart disease and the insulin-resistant patient. Nat Rev Cardiol 2, 252–260 (2005). https://doi.org/10.1038/ncpcardio0194

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