Insulin resistance and modulation/lipid-lowering therapy

  Medical studies have found that hypertension is often associated with coronary heart disease, dyslipidemia, diabetes mellitus or impaired glucose tolerance, hyperinsulinemia, overweight or obesity, and that these conditions often present in clusters in the same patient. This state in which common metabolic diseases in adults appear in clusters is called syndrome X or metabolic syndrome or CHAOS – disorder syndrome (C for coronary heart disease, H for hypertension, hyperinsulinemia, hyperlipidemia, A for adult diabetes, O for obesity, S for syndrome). Recent studies have concluded that insulin resistance is the common pathogenic basis for these conditions. Insulin resistance is a condition in which the biological effect of the body’s tissues on glucose uptake and utilization induced by a certain amount of insulin is lower than the expected normal level, i.e., the function of insulin to promote cellular uptake and utilization of glucose is diminished, so the body compensates by secreting more insulin and produces hyperinsulinemia. Recent medical studies have shown that insulin resistance is an independent risk factor for cardiovascular disease, and there is a growing consensus that coronary heart disease and hypertension are mostly associated with insulin resistance and hyperinsulinemia. It has been proposed that insulin resistance is the key to atherosclerosis, the central link to abnormal glucose and lipid metabolism, and is closely related to hemodynamic abnormalities. Recently, it has been reported that the severity of angiographically confirmed coronary artery lesions is closely related to blood insulin concentration. The effect of cardiovascular therapeutic drugs on insulin resistance has become an important indicator for evaluating the merits of the corresponding therapeutic drugs.  Hyperinsulinemia is closely associated with many coronary risk factors, including hypertension, dyslipidemia, elevated blood glucose, central obesity, masculinity (elevated plasma free testosterone), type A personality, and smoking, and the dyslipidemia caused by it is the most important among the risk factors for coronary heart disease. Studies have shown that the risk of developing coronary heart disease is influenced by blood lipid levels regardless of gender and age, and for every 1% increase in blood cholesterol levels, the incidence of coronary heart disease increases by 2% accordingly.  Since insulin resistance can cause dyslipidemia, and the latter is an important factor in the occurrence and development of cardiovascular disease, lipid regulation/lowering therapy should be beneficial for such patients. Several large international clinical trials in the 1990s proved that lipid regulating/lowering therapy with statins such as fluvastatin, pravastatin, simvastatin and lovastatin was beneficial to patients with coronary artery disease, regardless of whether they had hyperlipidemia, indicating that statin regulating/lowering drugs are effective drugs for secondary prevention of coronary artery disease. In another study, the use of statin lipid-modifying/lipid-lowering drugs was tested in men with hypercholesterolemia without a definite diagnosis of coronary artery disease, and these drugs were shown to be effective lipid-modifying/lipid-lowering agents for the primary prevention of coronary artery disease. It has been gradually recognized that lipid-modifying/lipid-lowering therapy in patients with pre-existing dyslipidemia significantly reduces the incidence of cardiovascular disease and mortality, and reduces the number of cardiovascular events. Recent studies suggest that lipid regulating/lowering therapy can improve insulin sensitivity and reduce insulin resistance. As for patients with only insulin resistance but not dyslipidemia or coronary heart disease, the benefits of lipid modifying/lowering therapy need to be clarified by medical research.