Abstract
Patients with type 2 diabetes mellitus (T2DM) are at high risk for macrovascular complications, which represent the major cause of mortality. Despite effective treatment of established cardiovascular (CV) risk factors, there remains a significant amount of unexplained CV risk.
Insulin resistance is associated with a cluster of cardiometabolic risk factors known collectively as the insulin resistance syndrome (IRS). Considerable evidence suggests that insulin resistance and the IRS contribute to this unexplained CV risk.
CV outcome trials with pioglitazone have demonstrated that this insulin-sensitizing thia-zolidinedione reduces CV events in high-risk patients with T2DM. In this review the roles of insulin resistance and the IRS in the development of atherosclerotic CV disease and the impact of antihyperglycemic medications on CV outcomes are discussed.