4.7 Article

Insulin resistance and compensatory hyperinsulinemia - The key player between cigarette smoking and cardiovascular disease?

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 41, Issue 6, Pages 1044-1047

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/S0735-1097(02)02982-0

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Hyperinsulinemia, dyslipidemia, and endothelial dysfunction are characteristic findings in insulin-resistant individuals, and all of these abnormalities have been identified as increasing cardiovascular disease (CVD) risk. Smokers tend to be relatively insulin resistant, hyperinsulinemic, and dyslipidemic, with evidence of endothelial dysfunction, as compared with nonsmokers, and recent epidemiologic data have suggested that CVD in smokers is primarily seen in those individuals who also have the characteristic findings of insulin resistance. Based on these observations, it is argued that insulin resistance and its consequences represent a major mechanistic link between cigarette smoking and CVD. It is also postulated that the enhanced CVD risk in smokers, resulting from hyperinsulinemia, abnormalities of lipoprotein metabolism, and endothelial dysfunction, will primarily be present in those smokers who are insulin resistant. As a corollary, it is suggested that CVD risk in individuals who cannot, or will not, stop smoking can be reduced by therapeutic efforts aimed at attenuating the adverse effects of insulin resistance and its consequences. (C) 2003 by the American College of Cardiology Foundation.

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