VIEWPOINT
Insulin resistance and compensatory hyperinsulinemia
The key player between cigarette smoking and cardiovascular disease?
Gerald Reaven, MD*,* and
Philip S. Tsao, PhD*
a Stanford University School of Medicine, Stanford, California, USA
Manuscript received September 5, 2002;
revised manuscript received November 11, 2002,
accepted November 27, 2002.
* Reprint requests and correspondence: Dr. Gerald Reaven, Division of Cardiovascular Medicine, Falk CVRC, Stanford University Medical Center, 300 Pasteur Drive, Stanford, California 94305, USA.
greaven{at}cvmed.stanford.edu
Hyperinsulinemia, dyslipidemia, and endothelial dysfunction are characteristic findings in insulin-resistant individuals, and all of these abnormalities have been identified as increasing cardiovascular disease (CVD) risk. Smokers tend to be relatively insulin resistant, hyperinsulinemic, and dyslipidemic, with evidence of endothelial dysfunction, as compared with nonsmokers, and recent epidemiologic data have suggested that CVD in smokers is primarily seen in those individuals who also have the characteristic findings of insulin resistance. Based on these observations, it is argued that insulin resistance and its consequences represent a major mechanistic link between cigarette smoking and CVD. It is also postulated that the enhanced CVD risk in smokers, resulting from hyperinsulinemia, abnormalities of lipoprotein metabolism, and endothelial dysfunction, will primarily be present in those smokers who are insulin resistant. As a corollary, it is suggested that CVD risk in individuals who cannot, or will not, stop smoking can be reduced by therapeutic efforts aimed at attenuating the adverse effects of insulin resistance and its consequences.
|
Abbreviations and Acronyms
| | ADMA | | asymmetric dimethylarginine | | ATP-III | | Adult Treatment Panel III | | CVD | | cardiovascular disease | | HDL | | high-density lipoprotein | | LDL | | low-density lipoprotein | | TG | | triglycerides |
|
This article has been cited by other articles:
|
|
|
|
 
Y. He, T. H. Lam, B. Jiang, J. Wang, X. Sai, L. Fan, X. Li, Y. Qin, and F. B. Hu
Combined effects of tobacco smoke exposure and metabolic syndrome on cardiovascular risk in older residents of china.
J. Am. Coll. Cardiol.,
January 27, 2009;
53(4):
363 - 371.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Missel, G. S. Mintz, S. G. Carlier, J. Qian, S. Shan, C. Castellanos, R. Kaple, S. Biro, M. Fahy, J. W. Moses, et al.
In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry
Eur. Heart J.,
September 1, 2008;
29(17):
2141 - 2147.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. B. Ness, J. Zhang, D. Bass, and M. A. Klebanoff
Interactions between Smoking and Weight in Pregnancies Complicated by Preeclampsia and Small-for-Gestational-Age Birth
Am. J. Epidemiol.,
August 15, 2008;
168(4):
427 - 433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Chiolero, D. Faeh, F. Paccaud, and J. Cornuz
Consequences of smoking for body weight, body fat distribution, and insulin resistance
Am. J. Clinical Nutrition,
April 1, 2008;
87(4):
801 - 809.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J R Payne, K I Eleftheriou, L E James, E Hawe, J Mann, A Stronge, P Kotwinski, M World, S E Humphries, D J Pennell, et al.
Left ventricular growth response to exercise and cigarette smoking: data from LARGE Heart
Heart,
December 1, 2006;
92(12):
1784 - 1788.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Warensjo, J. Sundstrom, L. Lind, and B. Vessby
Factor analysis of fatty acids in serum lipids as a measure of dietary fat quality in relation to the metabolic syndrome in men.
Am. J. Clinical Nutrition,
August 1, 2006;
84(2):
442 - 448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Park, X. Dong, T. L. Fisher, S. Dunn, A. K. Omer, G. Weir, and M. F. White
Exendin-4 Uses Irs2 Signaling to Mediate Pancreatic beta Cell Growth and Function
J. Biol. Chem.,
January 13, 2006;
281(2):
1159 - 1168.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Z. Stolzenberg-Solomon, B. I. Graubard, S. Chari, P. Limburg, P. R. Taylor, J. Virtamo, and D. Albanes
Insulin, Glucose, Insulin Resistance, and Pancreatic Cancer in Male Smokers
JAMA,
December 14, 2005;
294(22):
2872 - 2878.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Sherman
The Impact of Smoking and Quitting Smoking on Patients With Diabetes
Diabetes Spectr,
October 1, 2005;
18(4):
202 - 208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Weitzman, S. Cook, P. Auinger, T. A. Florin, S. Daniels, M. Nguyen, and J. P. Winickoff
Tobacco Smoke Exposure Is Associated With the Metabolic Syndrome in Adolescents
Circulation,
August 9, 2005;
112(6):
862 - 869.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Barnoya and S. A. Glantz
Cardiovascular Effects of Secondhand Smoke: Nearly as Large as Smoking
Circulation,
May 24, 2005;
111(20):
2684 - 2698.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Daskalopoulou, D. P. Mikhailidis, and M. Elisaf
Prevention and Treatment of the Metabolic Syndrome
Angiology,
November 1, 2004;
55(6):
589 - 612.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. S. Daskalopoulou, D. P. Mikhailidis, and M. Elisaf
Prevention and Treatment of the Metabolic Syndrome
Angiology,
November 1, 2004;
55(6):
589 - 612.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. A. Ambrose and R. S. Barua
The pathophysiology of cigarette smoking and cardiovascular disease: An update
J. Am. Coll. Cardiol.,
May 19, 2004;
43(10):
1731 - 1737.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Girod and D. J. Brotman
Does glucocorticoid dysregulation contribute to the link between cigarette smoking and insulin resistance?
J. Am. Coll. Cardiol.,
August 20, 2003;
42(4):
771 - 771.
[Full Text]
[PDF]
|
|
|
|
