cardiovascular-agents and Hyperinsulinism

Diabetic cardiomyopathy is characterized by a prominent interstitial fibrosis. Postulated etiologies include microangiopathy, autonomic neuropathy, and metabolic factors. A common root of these pathologies is hyperglycemia or hyperinsulinemia, both of which are prominent in type 2 diabetes mellitus, which has the highest incidence of cardiovascular morbidity and mortality. The relative importance of each factor is a matter of debate; it is likely that both of these factors in addition to the concomitant risk factors seen in diabetics (dyslipidemias, hypertension, obesity, coagulation abnormalities) contribute to the spectrum of myocardial disease in diabetes. A discussion of these contributive pathologies and the hyperglycemia and hyperinsulinemia that underlie them is the subject of this review. Treatment methodologies to control the development of such pathology also are discussed.

Topics: Albuminuria; Blood Coagulation Disorders; Cardiovascular Agents; Cause of Death; Coronary Disease; Diabetes Mellitus, Type 2; Female; Global Health; Heart Failure; Humans; Hyperinsulinism; Hyperlipidemias; Hypertension; Hypoglycemic Agents; Incidence; Insulin Resistance; Male; Obesity; Oxidative Stress; Prognosis; Risk Factors; Sex Characteristics; United States

Under certain circumstances the effect of insulin to promote glucose uptake in peripheral tissues is reduced because of a resistance to insulin action. This insulin resistance and the resulting hyperinsulinaemia are now recognised as common background factors that may be responsible for hypertension, hyperlipidaemia, decreased thrombolysis and also impaired glucose tolerance and diabetes. Hyperinsulinaemia has also been identified as an independent risk factor for coronary heart disease and promotes smooth muscle cell growth and plaque formation. A series of studies have now demonstrated that treatment with selective beta-blockers as well as thiazide diuretics impair insulin sensitivity by 15-30% and causes a compensatory increase in insulin concentrations. Furthermore, lipoprotein concentrations are affected in an unfavourable way. This is in contrast to the drugs belonging to ACE-inhibitors, calcium-channel blockers and alpha 1-blocker classes that are either neutral or may have the opposite effects in these respects.

Topics: Antihypertensive Agents; Cardiovascular Agents; Coronary Disease; Humans; Hyperinsulinism; Hypolipidemic Agents; Insulin Resistance

Topics: Angina Pectoris; Cardiovascular Agents; Hexamethonium; Humans; Hyperinsulinism; Hypoglycemia; Insulin; Muscle Relaxants, Central