Insulin resistance and hyperinsulinaemia often occur with many cardiovascular risk factors. Whether hyperinsulinaemia and insulin resistance are risk factors for coronary heart disease is still a matter of debate. The information from prospective population studies, in which the relationship between hyperinsulinaemia and coronary heart disease has been investigated, is summarized. The possibility that hyperinsulinaemia and insulin resistance increase the risk for coronary heart disease will be approached from two angles. Evidence is presented of how hyperinsulinaemia and insulin resistance increase the risk for coronary heart disease indirectly through their effects on cardiovascular risk factors. Finally, evidence of how hyperinsulinaemia and insulin resistance could directly promote atherosclerosis is reviewed.
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