Insulin resistance, hyperinsulinemia primary drivers of atherosclerotic CVD

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December 1, 2022

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Defronzo RA. Session 1: 20th WCIRDC Celebration – A Tribute to Gerald Leben. Presentation Location: World Conference on Insulin Resistance, Diabetes and Cardiovascular Disease. December 1-3, 2022. Universal City, CA (hybrid conference).

DeFronzo reports receiving research support, advice, or speaking fees from AstraZeneca, Bayer, Boehringer Ingelheim, and Janssen.

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Underlying insulin resistance and hyperinsulinemia together act as a ‘villain’, Atherosclerotic CVD Long before a person is diagnosed with type 2 diabetes, according to the speaker, early treatment is needed to slow the process.

“What is really killing us [diabetes] Patients have microvascular complications such as heart attack and stroke. ” Ralph A. DeFronzo, MD“It’s responsible for 80 percent of deaths in people with diabetes,” said Dr.

Atherosclerosis 3D_Adobe Stock

Underlying insulin resistance and hyperinsulinemia work together as a ‘villain’ in promoting ASCVD long before type 2 diabetes is diagnosed, requiring early treatment to slow the process.
Source: Adobe Stock

Obesity, diabetes, hypertension, and dyslipidemia are independent major risk factors for CVD. But underlying insulin resistance and compensatory hyperinsulinemia play a “key role” in directly driving the atherogenic process, he said.

Early data from insulin clamp studies measuring insulin sensitivity suggest that people with type 2 diabetes, whether overweight or underweight, are severely insulin resistant and observe defects in the glucose storage pathway doing. Similarly, adults with essential hypertension and hypertriglyceridemia also have severe insulin resistance without underlying obesity or dyslipidemia, he said.

Ralph A. Defronzo

“If you look at people with prediabetes, you can see that the disease started long before they developed diabetes. It could be an indication of sexuality,” DeFronzo said. “The data are very consistent.”

DeFronzo is Post-Stroke Insulin Resistance Intervention (IRIS) Trial Early intervention with thiazolidinedione pioglitazone has been shown to ‘reverse’ the development of atherosclerotic CVD in adults with prediabetes or normal glucose tolerance, giving clinicians an opportunity for early intervention. Data from IRIS show that the participant assigned pioglitazone during follow-up had a 30% reduction in his recurrent CV events compared to placebo, regardless of HbA1c, he said. .

“If we want to reduce this residual risk, we must consider different approaches to reverse this molecular defect, which is the major underlying cause of atherosclerosis.” said DeFronzo.

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