Insulin resistance is associated with subclinical
vascular disease that is not justified by conventional cardiovascular risk factors, such as smoking or
hypercholesterolemia.
Vascular injury associated to
insulin resistance involves functional and structural damage to the arterial wall that includes impaired vasodilation in response to chemical mediators, reduced distensibility of the arterial wall (arterial stiffness),
vascular calcification, and increased thickness of the arterial wall. Vascular dysfunction associated to
insulin resistance is present in asymptomatic subjects and predisposes to
cardiovascular diseases, such as
heart failure,
ischemic heart disease,
stroke, and
peripheral vascular disease. Structural and functional
vascular disease associated to
insulin resistance is highly predictive of cardiovascular morbidity and mortality. Its pathogenic mechanisms remain undefined. Prospective studies have demonstrated that animal
protein consumption increases the risk of developing
cardiovascular disease and predisposes to
type 2 diabetes (T2D) whereas
vegetable protein intake has the opposite effect.
Vascular disease linked to
insulin resistance begins to occur early in life. Children and adolescents with
insulin resistance show an injured arterial system compared with youth free of
insulin resistance, suggesting that
insulin resistance plays a crucial role in the development of initial vascular damage. Prevention of the vascular dysfunction related to
insulin resistance should begin early in life. Before the clinical onset of T2D, asymptomatic subjects endure a long period of time characterized by
insulin resistance. Latent vascular dysfunction begins to develop during this phase, so that patients with T2D are at increased cardiovascular risk long before the diagnosis of the disease.