Insulin Resistance, Diabetes, and Cardiovascular Risk
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Obesity and type 2 diabetes mellitus (T2DM) are major drivers of cardiovascular disease (CVD). The link between environmental factors, obesity, and dysglycemia indicates that progression to diabetes with time occurs along a “continuum”, not necessarily linear, which involves different cellular mechanisms including alterations of insulin signaling, changes in glucose transport, pancreatic beta cell dysfunction, as well as the deregulation of key genes involved in oxidative stress and inflammation. The present review critically addresses key pathophysiological aspects including (i) hyperglycemia and insulin resistance as predictors of CV outcome, (ii) molecular mechanisms underpinning the progression of diabetic vascular complications despite intensive glycemic control, and (iii) stratification of CV risk, with particular emphasis on emerging biomarkers. Taken together, these important aspects may contribute to the development of promising diagnostic approaches as well as mechanism-based therapeutic strategies to reduce CVD burden in obese and diabetic subjects.
KeywordsInsulin resistance Diabetes Cardiovascular disease
Research discussed in this manuscript was supported by the Swiss Heart Foundation and the Italian Ministry of Education, University and Research, PRIN 2010-2011 (to F.C.). F.P was the recipient of a Ph.D. program in Experimental Medicine at the University of Rome “Sapienza”.
Compliance with Ethics Guidelines
Conflict of Interest
Francesco Paneni and Sarah Costantino declare that they have no conflicts of interest.
Francesco Cosentino reports grants from the Swiss Heart Foundation, the Italian Ministry of Education, University and Research, PRIN 2010-2011, personal fees from Roche, personal fees from Bristol Myers Squibb, personal fees from MSD, personal fees from Abbott, and personal fees from Astra Zeneca.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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