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Figure 3 Reciprocal Relationships Between Vascular and Metabolic Actions of Insulin in Health and Disease

(A) Parallel phosphatidylinositol (PI) 3-kinase-dependent insulin signaling pathways in metabolic and vascular tissues synergistically couples metabolic and vascular physiology under healthy conditions. (B) Parallel impairment in insulin signaling pathways under pathological conditions contributes to synergistic coupling of insulin resistance (IR) and endothelial dysfunction (80). eNOS = endothelial nitric oxide synthase; FFA = free fatty acid; IKKß = inhibitor of nuclear factor kappa B kinase beta; IRS = insulin receptor substrate; NO = nitric oxide; PDK = phosphoinositide-dependent kinase; PKC = protein kinase C zeta.