When people think about heart disease, they think about cholesterol. When I look at a patient’s labs, one of the first things I look for is something most standard checkups barely mention: insulin resistance. It’s one of the most powerful — and most overlooked — drivers of heart disease, and it’s usually at work for years before anyone is told they’re “diabetic.”
What insulin resistance is, in plain terms
Insulin is the hormone that moves sugar out of your blood and into your cells. When cells stop responding to it well, the body compensates by pumping out more and more insulin. That chronically high insulin — long before blood sugar looks abnormal — quietly promotes inflammation, raises triglycerides, lowers protective HDL, drives up blood pressure, and makes cholesterol particles smaller and more damaging. In other words, it turns the dials that lead to heart disease.
The markers I actually watch
You don’t need exotic testing to catch it early. A few clues on an ordinary panel tell the story: a high triglyceride-to-HDL ratio, a fasting insulin that’s creeping up, a hemoglobin A1c drifting into the “pre” range, and expanding waist size. These often flash red years before a diabetes diagnosis — which is exactly when intervention works best.
The good news: it’s often reversible
This is the part I love telling patients. Insulin resistance responds to lifestyle faster than almost anything else in cardiology. Reducing refined carbohydrates and sugar, prioritizing protein and fiber, moving after meals, lifting weights to build insulin-hungry muscle, sleeping well, and managing stress can move these numbers substantially — sometimes in weeks. I’ve watched triglycerides fall by half and HDL climb without a single new prescription.
Why this matters for how we prevent heart disease
If we only chase cholesterol while ignoring the metabolic engine underneath, we’re treating a gauge instead of the machine. Addressing insulin resistance is, to me, one of the highest-leverage things a person can do for their heart — and it’s squarely within your control.
This is general education, not medical advice. Any changes to your care should be made with your own physician.
About the author: Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist with more than two decades of experience. He works as a consultant helping patients take a natural, root-cause approach to heart health — through diet, lifestyle, and targeted supplements — seeing patients nationwide via telehealth through Natural Heart Doctor. He is licensed in New York and Tennessee and has been featured as an expert source in Medscape and Men’s Journal. Learn more at andrewrudin.com.
This article is for general educational purposes and is not medical advice. It is not a substitute for care from your own physician, and nothing here should be used to start, stop, or change any treatment on your own.