Insulin resistance – a common enemy for endocrinologists and cardiologists


DOI: https://dx.doi.org/10.18565/pharmateca.2021.12.26-35

A.F. Verbovoy, Yu.A. Dolgikh

Samara State Medical University, Department of Endocrinology, Samara, Russia
Insulin resistance (IR) is a pathological condition with decreased sensitivity of some tissues to insulin. Such tissues include adipose, muscle and liver tissue. IR is most often detected in abdominal (visceral) obesity. It is known that it is the visceral adipose tissue that leads to the development of IR due to its pathophysiological characteristics. Abdominal adipocytes have a high density of β-adrenergic receptors, corticosteroid and androgen receptors and a relatively lower density of α2-adrenergic receptors and insulin receptors. In addition, adipocyte hypertrophy, their infiltration and microcirculation disorders occur. Leptin, resistin and adiponectin, the hormones of adipose tissue (adipokines), also play a role. Insulin resistance is a factor that increases the likelihood and further progression of cardiovascular disease. IR is the main interlink for all components of the metabolic syndrome: arterial hypertension, dyslipidemia, disorders of carbohydrate metabolism. This dictates the need for the earliest possible detection of IR and its correction. The drugs correcting IR include metformin, glucagon-like peptide-1receptor agonists (GLP-1RA), sodium-glucose linked transporter-2 (SGLT-2) inhibitors. Metformin has a direct effect on IR. In addition, it helps protect the cardiovascular system. These protective effects of metformin include weight loss, improved hemostatic function, reduced inflammation and oxidative stress, and inhibition of key steps in the atherosclerosis process. GLP-1RA and SGLT-2 inhibitors improve insulin sensitivity by reducing body weight, which also improves cardiovascular prognosis. Some antihypertensive drugs can also affect IR. Nevertheless, there are certain difficulties in influencing IR and reducing the incidence of cardiovascular diseases. They are attributable to the low quality of outpatient care, the use of ineffective drugs, as well as the low awareness of patients with obesity and comorbidities about cardiovascular risk factors and inadequate adherence to treatment.

About the Autors


Corresponding author: Andrey F. Verbovoy, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Samara State Medical University, Samara, Russia; andreyy.verbovoyy@rambler.ru


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