How To Reduce The Risk Of Heart Disease If You Have Insulin Resistance.
Insulin resistance is a major driver of risk but it can be tamed.
Coronary artery disease is caused by the retention of a cholesterol particle in the artery wall.
This is the spark that sets the fire.
But if a retained cholesterol particle is the spark.
Insulin resistance is the gasoline poured on that spark.
Everyone exists on a spectrum from insulin-sensitive to insulin-resistant.
On the far end of that line is type two diabetes.
Insulin resistance and diabetes may not ‘cause’ coronary artery disease, but they are huge accelerants.
In fact, when considering the contribution of risk for cardiovascular disease, diabetes and its early manifestations, such as metabolic syndrome and insulin resistance, are some of the biggest drivers of risk.
Compared to someone without type 2 diabetes, the person with type 2 diabetes has a risk that is tenfold higher1.
There are many things you want to avoid to prevent heart disease, but type 2 diabetes and extreme insulin resistance needs to be right up there at the top of that list.
Let me be 100% clear, however.
Avoiding diabetes and being at the other end of the scale of insulin resistance does not preclude you from getting heart disease.
It just makes it much less likely.
I have seen many patients with exquisite insulin sensitivity with fasting insulin levels in the low single digits with multi-vessel coronary artery disease.
Timing Matters.
We also know that WHEN you get type 2 diabetes makes a huge difference.
While pretty much everyone will develop coronary artery disease at some point in their lives if they live long enough, developing diabetes can pull forward the onset of coronary artery disease by over ten years2.
If delaying the onset of major chronic disease is your goal.
Delaying or avoiding insulin resistance has to be on your priority list.
You can still reduce risk.
For those with insulin resistance or its more advanced phenotype, type 2 diabetes, it can feel that there is little you can do to reduce risk.
This is untrue.
There is a lot you can do.
A future article will discuss how to reverse type 2 diabetes but I want to look at the impact of how getting multiple smaller factors right can make a big difference to future life span.
Seven Factors
Let’s look at seven separate healthy factors.
Not smoking
Being physically active
Good nutrition
Achieving target HBA1c levels
Normal weight
Normal blood pressure
Normal total cholesterol
Whether or not a person with type 2 diabetes hits any or all of these metrics matters a lot.
How much?
How about seven additional years of life expectancy3.
That. Is a lot.
For those aged 50 who achieved either none or only one of these factors, they lost 7.6 years of life expectancy compared to someone without diabetes.
However, for those who managed to hit 6 to 7 of these health metrics, that loss of life expectancy fell to (just) under one year.
Not a complete elimination of risk.
But a huge reduction.
The relationship is clear.
If you have diabetes, the more healthy factors you can put in place, the longer you are likely to live.
Why are these people living longer?
Very simple.
They are dying less often from the two leading causes of death:
Cardiovascular Disease and Cancer.
For each factor achieved, the risk of dying from either of these two conditions drops significantly.
To the point that those with 6 to 7 of the healthy factors in place had essentially eliminated the increased risk of dying from cardiovascular disease or cancer compared to those without type 2 diabetes.
It’s Never Too Late.
To be clear, I am not proposing you just wait until you develop type 2 diabetes to start getting all of these healthy factors in place.
But I am saying that even if you have developed type 2 diabetes, which is a major driver of risk, there is still a huge amount that can be done to reduce future risk.
But why wait?
We know that getting most of these same factors in line early in life can mean avoiding type 2 diabetes entirely4.
Yes, there is a genetic predisposition at play.
For sure. (I know because I have some of those genes).
But those genes are probabilistic, not deterministic.
They set the odds. But they don’t guarantee the outcome.
It Starts Now.
Everyone starts from where they are now.
Whether that is from a place of insulin sensitivity and low future risk.
Or from the starting point of severe insulin resistance and type 2 diabetes.
Regardless of where you start, there is a clear path to avoiding future risks.
Even if you already have type 2 diabetes, there is a huge amount that can be done to mitigate that risk.
Remember, we are always working with odds.
Even if type 2 diabetes has tilted those odds against you, there is a lot you can do to bend the risk curve back in place.
There is hope.
But hope is not a plan.
Getting the above seven health metrics in place.
That is a plan.
P.S. If you want a plan to address cardiovascular risk, The Heart Health Formula - Complete & Express version are now available. If you are someone who is looking to make a big difference to their cardiovascular health they are a great place to start. You can learn more by clicking here.
Heart. An Owner’s Guide.
My new book, Heart. An Owner’s Guide will be released next week on May 2nd in the UK and Ireland. The release date is May 7th in the USA.
For those of you who pre-ordered via Eason’s or Waterstones, you may already have your copy in hand.
If you enjoy the content I write about here, the book covers all these topics and more in an accessible format, with two-page spreads on each area of interest.
In general, it is a lifestyle-first approach to preventing heart disease.
You can pre-order a copy by clicking here or on the image below.
Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol 2021;6:437–47
10-Year Cardiovascular Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023 Oct, 82 (16) 1583–1594.
Assessing the impact of type 2 diabetes on mortality and life expectancy according to the number of risk factor targets achieved: an observational study. BMC Med 22, 114 (2024).
Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis. 2023 Jul 6:S0939-4753(23)00273-9.
Obrigado Dr, muito útil essas informações
Thanks Dr. Barrett for all the helpful advice. Every success with the book. I will be buying it for sure