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The British Journal of Diabetes & Vascular Disease
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Insulin resistance, haemostatic factors and cardiovascular risk

Joseph D Mills

Academic Unit of Molecular Vascular Medicine, G Floor, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, UK, j.d.mills{at}leeds.ac.uk

Peter J Grant

Increased insulin resistance, which is present in the majority of type 2 diabetics patients, is associated with other metabolic and pro-coagulant cardiovascular risk factors and may account for the accelerated atherosclerosis and increased thrombotic potential observed in these patients. In individuals with normoglycaemia or impaired glucose tolerance (IGT), hyperinsulinaemia (a marker of insulin resistance) is associated with a similar clustering of risk factors and is predictive of cardiovascular events. The origins of insulin resistance are not well understood but data from families, twins and extended pedigrees suggest significant genetic and environmental contributions. The clustering of atherogenic traits begins in childhood, carries through to adult life and may result from the multiple effects of individual genes (pleiotropy) and environmental influences. Important environmental determinants of insulin resistance may occur before birth and, in conjunction with subsequent diet and exercise habits which result in obesity, lead to increased insulin resistance and cardiovascular risk. Therefore, primary prevention should centre around lifestyle changes which increase insulin sensitivity, maintain normoglycaemia and ameliorate atherothrombotic risk factor clustering.

Key Words: insulin resistance • haemostatic factors • cardiovascular disease • pleiotropy • environmental factors.

The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 1, 19-26 (2002)
DOI: 10.1177/14746514020020011301
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