Narrative review reveals how adipose tissue dysregulation drives endothelial dysfunction in insulin resistance, highlighting selective signaling pathway blocks that elevate cardiovascular risk.
Summary: Introduction of abdominal obesity as a crucial part of the metabolic syndrome pointed out that adipose tissue dysregulation might play a main role in the pathogenesis of insulin resistance and atherosclerosis. Excess of fatty acids in circulation creates resistance in periphery insulin by the added substrate availability and by modifying insulin downstream signalling. Patients with insulin have endothelial dysfunction with a partial or complete loss of balance between vasoconstrictors and vasodilatators, growth promoting and inhibiting factors, proatherogenic and antiatherogenic, and procoagulant and anticoagulant factors. Insulin resistant individuals may have a partial block to insulin action through PI(3)K pathway in skeletal muscle and endothelial cells with an intact MAPK pathway that may partially explain their increased cardiovascular risk.
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Dragan Micić (2006) studied this question.
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