Insulin resistance and its targeting in clinical practice

Authors: Jan Škrha Jr
Authors‘ workplace: III. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in: AtheroRev 2021; 6(2): 73-75
Category: Reviews


Cardiovascular complications represent the major cause of mortality in patients with Type 2 diabetes. Despite effective treatment of established cardiovascular (CV) risk factors, there remains some unexplained CV risk. Considerable evidence suggests that insulin resistance contributes to this unexplained CV risk. This review summarizes the roles of insulin resistance in the development of atherosclerotic CV disease and the impact of various treatment options. Apart from non-pharmacologic approaches there is the need of complex pharmacologic intervention of main risk factors together with addition of pioglitazone, the most effective antidiabetic drug in reduction of insulin resistance.


type 2 diabetes mellitus – insulin resistance – cardiovascular complication – pioglitazone – pharmacological intervention


1. Gast KB, Tjeerdema N, Stijnen T et al. Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis. PLoS One 2012; 7(12): e52036. Dostupné z DOI: .

2. Ferrannini E, Balkau B, Coppack SW et al. Insulin resistance, insulin response, and obesity as indicators of metabolic risk. J Clin Endocrinol Metab 2007; 92(8): 2885–2892. Dostupné z DOI: .

3. Haffner SM, Lehto S, Rönnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229– 234. Dostupné z DOI: .

4. D’Agostino RB, sr, Grundy S, Sullivan LM et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. Jama 2001; 286(2): 180–187. Dostupné z DOI: .

5. Rawshani A, Rawshani A, Franzen S et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med 2017; 376(15): 1407– 1418. Dostupné z DOI: .

6. Dansinger ML, Tatsioni A, Wong JB et al. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med 2007; 147(1): 41–50. Dostupné z DOI: .

7. Anderson JW, Konz EC, Frederich RC et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001; 74(5): 579– 584. Dostupné z DOI: .

8. Kastorini CM, Milionis HJ, Esposito K et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011; 57(11): 1299–1313. Dostupné z DOI: .

9. Dormandy JA, Charbonnel B, Eckland DJ et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 2005; 366(9493): 1279–1289. Dostupné z DOI: .

10. Lewis JD, Habel LA, Quesenberry CP et al. Pioglitazone Use and Risk of Bladder Cancer and Other Common Cancers in Persons With Diabetes. JAMA 2015; 314(3): 265–277. Dostupné z DOI: .

11. Di Pino A, DeFronzo RA. Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents. Endocrine Reviews 2019; 40(6): 1447–1467. Dostupné z DOI: .

12. Golden SH, Folsom AR, Coresh J et al. Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the atherosclerosis risk in communities study. Diabetes 2002; 51(10): 3069–3076. Dostupné z DOI: .

Angiology Diabetology Internal medicine Cardiology General practitioner for adults
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account