Hyperinsulinemia, Hyperglycemia, and Impaired Hemostasis

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Abstract
Type 2 diabetes mellitus and its precursor, impaired glucose tolerance (IGT), are associated with increased risk for morbidity and mortality from cardiovascular disease (CVD), particularly coronary heart disease.1,2 An increased prevalence of traditional risk factors for atherosclerosis (eg, hypertension, low high-density lipoprotein cholesterol [HDL-C] levels) occurs in type 2 diabetes and IGT, but these factors account for only half of the observed excess risk for CVD.3 Novel CVD risk factors, including insulin resistance and hyperinsulinemia, have been proposed to account for excess CVD risk in glucose intolerance.4,5 However, the role of hyperinsulinemia as an independent risk factor for CVD remains uncertain; its apparent effect could be due to other factors rather than to the direct toxicity of insulin itself.6