journal of internal medicine
Vol. 10, No. 2 Mei 2009


Ridwan, Muhammad (Unknown)
Gotera, Wira (Unknown)

Article Info

Publish Date
27 Nov 2012


Insulin is an anabolic hormone responsible for regulation of glucose metabolism and signals for storage and usage ofmany fundamental nutrients such as glucose, amino acids, and fatty acids. Its effects on cardiovascular function, reveal widerearly-known insulin actions, are based on the balance between its NO-dependent vasodilator action and endothelin-1-dependentvasocontriction action regulated by signals through phosphatidylinositole 3-kinase (PI3K) and mitogen-activated protein kinase(MAPK)-dependent pathways on vascular endothelial cells. On insulin resistance setting, signal perturbances of PI3K pathwayand enhanced signals through MAPK pathway are conditions underlying link between metabolic disorders and cardiovasculardiseases. Insulin also has antiinflammatory effects by suppressing expression of ICAM-1, MCP-1, NF-kB, MMP-9 and CRP. Onthe heart, insulin increases contractility and plays important roles in maximazing heart glucose uptake particularly in stress states.In addition, insulin plays a role in physiologic heart growth through Akt pathway. However, chronic exposure of insulin isassociated with ventricular disfunction. In term of cardiovascular function, insulin is known to increase peripheral blood flow danto decrease peripheral resistance, so that results in enhanced cardiac output without significant changes in blood pressure.Not only can improved insulin action repair glucose metabolism, but also improve risks underlying atherosclerosis andcardiovascular complications of diabetes. In 2007, European Cardiac Society (ESC) has recommended intensive insulin usage totightly control blood glucose in order to improve adult critically ill and heart surgery patient mortality and morbidity

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