Insulin resistance and its metabolic, lipid and cardiovascular consequences

Many research groups on atherosclerosis have sought through prospective large-scale epidemiological studies to better understand which residual factors would be associated with cardiovascular risk. Thus, atherogenic dyslipidemia was defined, such as the presence in an individual of decreased HDL-C levels, increased triglyceride levels, and a relatively high proportion of small and dense LDL-C particles. On the other hand, it was found that atherogenic dyslipidemia is present in cases of insulin resistance and metabolic syndrome (low HDL-C and elevated triglycerides are part of the definition of this syndrome) and consequently in patients with type 2 diabetes mellitus. Regarding treatment, there are studies in diabetic patients with risk reduction with fenofibrate, and the guidelines recommend the association of fenofibrate with statins. Diabetes mellitus is also an important cause of hospitalizations and proportional mortality, also assuming that most deaths register only the immediate cause of this death, which is often the result of diabetes complications. Most of these complications are cardiovascular diseases, which may manifest as coronary heart disease, cerebrovascular disease or peripheral arteriopathies. These are the so-called macrovascular complications of type 2 diabetes and are present even before the onset of hyperglycemia, due to the presence of insulin resistance and associated metabolic syndrome. Metabolic syndrome is characterized by the presence in the patient of at least 3 out of 5 parameters (increased abdominal waist, high glycemia, hypertriglyceridemia, low HDL-C and arterial hypertension) and is one of the factors responsible for the macrovascular changes.