Ronald F. Feinberg: Insulin Resistance May Be an Overlooked Cardiovascular Risk Factor
Ronald F. Feinberg, Medical Advisor and Care Council Member at Fyrtle, shared a post on LinkedIn about a recent article by Henning Bundgaard et al., published in New England Journal of Medicine, adding:
”Insulin resistance: the cardiovascular (and fertility) risk factor we still don’t routinely measure?
A remarkable new New England Journal of Medicine study examined silent atherosclerosis in 16,808 adults ages 18–70.
I searched the paper for two terms:
‘Insulin’ — zero mentions.
‘Insulin resistance’ — zero mentions.
That may be as interesting to me as some of the study’s findings.
Atherosclerosis was already present in 8.7 percent of men and 6.7 percent of women ages 18–29.
By ages 30–39, it was present in 34.6 percent and 21.3 percent, respectively.
The investigators assessed BMI, blood pressure, lipids, inflammation, smoking and other conventional cardiovascular risk factors.
But apparently not insulin.
Insulin resistance is not synonymous with elevated glucose.
For years, glucose can remain normal because the pancreas compensates by producing more insulin.
I’ve spent much of my career thinking about this in PCOS/PMOS and reproductive health.
But the implications extend far beyond fertility.
This study doesn’t tell us whether hyperinsulinemia contributed to this surprisingly early atherosclerosis.
It can’t.
They didn’t measure it.
Maybe insulin would add little.
Maybe it would tell us a great deal.
But shouldn’t we know?”
Title: Prevalence of Silent Atherosclerosis across Adult Life
Authors: Henning Bundgaard, Inés García-Lunar, Klaus F. Kofoed, Rasmus Hasselbalch, Carlos Nicolás Pérez-García, Joakim Bo Kunkel, Frederik Filip Stæger, Fátima Sánchez-Cabo, José J. Fuster, Virginia Mass, Javier Sánchez-González, Maja V. Kragh, Anna K. Ringgaard, Javier Valls-Monzó, Michael Huy Cuong Pham, Ana Devesa, Morten Sejer, Per Sigvardsen, Antonio Quesada, Charlotte Eberhard, Ana García-Álvarez, Lea Marie Pehrson, Álvaro Navarro-Guzmán, Simon Winther, Mathias Sørgaard, Marcos Gámez, Martin Lundsgaard, Cristina Pérez-Herreras, Ruth Frikke-Schmidt, Pedro L. Sánchez, Nikolaj Eldrup, Juan Torres-Macho, Morten Bøttcher, Valentin Fuster, Kasper K. Iversen, Borja Ibanez
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