Molecular Activity of Insulin and Selective Insulin Resistance.
CME Review Article #35
Endocrinologist. 17(6):351-356, November/December 2007.
Marquezine, Guilherme Figueiredo MD *; Wajchenberg, Bernardo Leo MD +
Abstract:
Insulin resistance is a relevant condition with progressively increasing prevalence in most parts of the modern world, leading to clinical and socio-economical impact. Even though the intrinsic relation between insulin resistance and atherosclerosis has been observed for decades, we are still struggling to find the exact link and physiopathologic mechanisms of insulin, its action, and the development of diabetes, accelerated atherosclerosis, and cardiovascular disease. In this article, we review some of the complex features of insulin and insulin resistance in the evolution of cardiovascular disease. These actions are diverse and evidence shows interesting data demonstrating the role of insulin in many molecular phenomena, such as reducing endothelial dysfunction through nitric oxide production, acting against endothelial inflammation, and helping to keep balanced 2 antagonic processes that are of fundamental importance in the plaque rupture process: thrombogenesis and thrombolysis. We report data that suggests that insulin can have very distinct action in these processes, according to an equilibrium of signalling intensity down its 2 transduction postreceptor pathways, ultimately controlled by the degree of insulin resistance that can be observed. Practical implications of this body of evidence are suggested but need clinical studies to confirm their place in medical practice.
(C) 2007 Lippincott Williams & Wilkins, Inc.