Insulin resistance: Is it time for primary prevention?

Table 1 Pathologic changes associated with insulin resistance and compensatory hyperinsulinemia

Alterated glucose metabolism:

Impaired fasting glucose

Impaired glucose tolerance

Diabetes

Dyslipidemia:

↑ Triglycerides

↓ HDL-C

↑ Small, dense LDL-particles

Endothelial dysfunction:

↑ Adhesion molecules

↓ Endothelial-dependent vasodilation

↓ NO and ↑ ET-1 production

Hypercoagulability:

↑ Plasminogen activator inhibitor-I

↑ Fibrinogen

Hemodynamic changes:

↑ Sympathetic nervous system activity

↑ Renal sodium retention

↑ Cardiac mass

VSMC hypertrophy

Chronic inflammation:

↑ C-reactive protein, TNF-α, IL-6, resistin, leptin

↓ Adiponectin

↑ Oxidative stress

HDL-C: High density lipoprotein-cholesterol; LDL: Low density lipoprotein; NO: Nitric oxide; ET-1: Endothelin-1; VSMC: Vascular smooth muscle cells; TNF-α: Tumor necrosis factor-α; IL: Interleukin.