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Insulin and Its Cardiovascular Effects: What Is the Current Evidence?

  • Macrovascular Complications in Diabetes (VR Aroda and A Getaneh, Section Editors)
  • Published:
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Abstract

Purpose of Review

In this article, we examine the nature of the complex relationship between insulin and cardiovascular disease. With metabolic abnormalities comes increased risk for cardiovascular complications. We discuss the key factors implicated in development and progression of cardiovascular disease, its relationship to insulin therapy, and what can be learned from large, recent cardiovascular outcome studies.

Recent Findings

Preclinical studies suggest that insulin has positive effects of facilitating glucose entry into cells and maintaining euglycemia and negative effects of favoring obesity and atherogenesis under certain conditions. Confounding this relationship is that cardiovascular morbidity is linked closely to duration and control of diabetes, and insulin is often used in patients with diabetes of longer duration. However, more recent clinical studies examining the cardiovascular safety of insulin therapy have been reassuring.

Summary

Diabetes and cardiovascular outcomes are closely linked. Many studies have implicated insulin resistance and hyperinsulinemia as a major factor for poor cardiovascular outcomes. Additional studies link the anabolic effects of therapeutic insulin to weight gain, along with hypoglycemia, which may further aggravate cardiovascular risk in this population. Though good glycemic control has been shown to improve microvascular risks in type 1 and type 2 diabetes, what are the known cardiovascular effects of insulin therapy? The ORIGIN trial suggests at least a neutral effect of the basal insulin glargine on cardiovascular outcomes. Recent studies have demonstrated that ultra-long-acting insulin analogs like insulin degludec are non-inferior to insulin glargine with regard to cardiovascular outcomes.

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Authors and Affiliations

  1. MedStar Union Memorial Hospital, 201 East University Parkway, 33rd Street Professional Building, Baltimore, MD, 21218, USA

    Sahana Pai Dongerkery, Pamela R. Schroeder & Mansur E. Shomali

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  1. Sahana Pai Dongerkery
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  2. Pamela R. Schroeder
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  3. Mansur E. Shomali
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Correspondence to Mansur E. Shomali.

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Sahana Pai Dongerkery, Pamela R. Schroeder, and Mansur E. Shomali declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Macrovascular Complications in Diabetes

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Dongerkery, S.P., Schroeder, P.R. & Shomali, M.E. Insulin and Its Cardiovascular Effects: What Is the Current Evidence?. Curr Diab Rep 17, 120 (2017). https://doi.org/10.1007/s11892-017-0955-3

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