INSULIN RESISTANCE AND CARDIOVASCULAR DISEASES: AN INTEGRATIVE REVIEW ON MECHANISMS AND CLINICAL IMPACTS
DOI:
https://doi.org/10.56238/arev7n12-287Keywords:
Insulin Resistance, Cardiovascular Diseases, Endothelial Dysfunction, Hyperinsulinemia, InsulinAbstract
Insulin resistance (IR) is a central metabolic disorder in the pathophysiology of type 2 diabetes mellitus and has been recognized as an independent risk factor for the development of cardiovascular diseases (CVD). Considering the high prevalence of IR in the adult population and its association with increased cardiovascular morbidity and mortality, understanding the mechanisms underlying this relationship is essential. This study aims to integratively analyze scientific evidence regarding the pathophysiological mechanisms and clinical impacts of insulin resistance on the cardiovascular system. To this end, a narrative literature review was conducted using PubMed, SciELO, and CAPES Journals databases, with controlled descriptors in Portuguese and English, covering publications from 2016 to 2024. The analyzed studies indicate that IR impairs insulin signaling, particularly the PI3K/Akt pathway, reducing nitric oxide bioavailability and promoting inflammation, endothelial dysfunction, and vascular remodeling. Additionally, a consistent association between hyperinsulinemia and increased incidence of myocardial infarction, stroke, and heart failure was observed. It is concluded that insulin resistance represents a relevant pathophysiological link between metabolic disorders and cardiovascular disease, highlighting the importance of preventive and therapeutic strategies aimed at improving insulin sensitivity.
Downloads
References
BATISTA, T. M.; HAIDER, N.; KAHN, C. R. Defining the underlying defect in insulin action in type 2 diabetes. Diabetologia, v. 64, n. 5, p. 994-1006, maio 2021. DOI 10.1007/s00125-021-05415-5.
BRASIL já tem cerca de 20 milhões de pessoas com diabetes. Disponível em: https://diabetes.org.br/brasil-ja-tem-cerca-de-20-milhoes-de-pessoas-com-diabetes/. Publicado em 31 jan. 2025. Acesso em: 17 fev. 2025.
DA SILVA ROSA, S. C.; NAYAK, N.; CAYMO, A. M.; GORDON, J. W. Mechanisms of muscle insulin resistance and the cross-talk with liver and adipose tissue. Physiol Rep., v. 8, n. 19, e14607, out. 2020. DOI 10.14814/phy2.14607.
DE OLIVEIRA, G. M. M. et al. Estatística Cardiovascular – Brasil 2023. Arquivos Brasileiros de Cardiologia, v. 121, n. 2, p. e20240079, 2024.
DING, P. F.; ZHANG, H. S.; WANG, J.; GAO, Y. Y.; MAO, J. N.; HANG, C. H.; LI, W. Insulin resistance in ischemic stroke: Mechanisms and therapeutic approaches. Front Endocrinol (Lausanne)., v. 13, 1092431, 15 dez. 2022. DOI 10.3389/fendo.2022.1092431.
FAN, Y. et al. Primordial Drivers of Diabetes Heart Disease: Comprehensive Insights into Insulin Resistance. Diabetes Metab J., v. 48, n. 1, p. 19-36, jan. 2024. DOI 10.4093/dmj.2023.0110.
FERRARI, F. et al. Biochemical and Molecular Mechanisms of Glucose Uptake Stimulated by Physical Exercise in Insulin Resistance State: Role of Inflammation. Arquivos Brasileiros de Cardiologia, v. 113, n. 6, p. 1139–1148, dez. 2019.
HALL, C.; YU, H.; CHOI, E. Insulin receptor endocytosis in the pathophysiology of insulin resistance. Exp Mol Med., v. 52, n. 6, p. 911-920, jun. 2020. DOI 10.1038/s12276-020-0456-3.
HILL, M. A.; YANG, Y.; ZHANG, L.; SUN, Z.; JIA, G.; PARRISH, A. R.; SOWERS, J. R. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism., v. 119, 154766, jun. 2021. DOI 10.1016/j.metabol.2021.154766.
JIA, G.; DEMARCO, V. G.; SOWERS, J. R. Insulin resistance and hyperinsulinaemia in diabetic cardiomyopathy. Nat Rev Endocrinol., v. 12, n. 3, p. 144-153, mar. 2016. DOI 10.1038/nrendo.2015.216.
KOSMAS, C. E.; BOUSVAROU, M. D.; KOSTARA, C. E.; PAPAKONSTANTINOU, E. J.; SALAMOU, E.; GUZMAN, E. Insulin resistance and cardiovascular disease. Journal of International Medical Research, v. 51, n. 3, 2023. DOI 10.1177/03000605231164548.
LEE, S. H.; PARK, S. Y.; CHOI, C. S. Insulin Resistance: From Mechanisms to Therapeutic Strategies. Diabetes Metab J., v. 46, n. 1, p. 15-37, jan. 2022. DOI 10.4093/dmj.2021.0280.
PADILLA, J.; MANRIQUE-ACEVEDO, C.; MARTINEZ-LEMUS, L. A. New insights into mechanisms of endothelial insulin resistance in type 2 diabetes. Am J Physiol Heart Circ Physiol., v. 323, n. 6, p. H1231-H1238, 1 dez. 2022. DOI 10.1152/ajpheart.00537.2022.
PETERSEN, M. C.; SHULMAN, G. I. Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev., v. 98, n. 4, p. 2133-2223, 1 out. 2018. DOI 10.1152/physrev.00063.2017.
YANG, Y.; WANG, T. T.; XIE, H. A.; HU, P. P.; LI, P. Experimental cell models of insulin resistance: overview and appraisal. Front Endocrinol (Lausanne)., v. 15, 1469565, 19 dez. 2024. DOI 10.3389/fendo.2024.1469565.
