Impaired wound healing at the endothelial level in individuals with insulin resistance prevents proper repair, leading to the initiation of atherosclerosis.

“i think that the reason that atherosclerosis happens is because the blood vessels become insulin resistant”

“what we need for atherosclerosis to begin is a damaged endothelium and i think that is the key here that ldl isn't damaging the endothelium or we would see denovo atherosclerosis in veins the endothelium must be damaged for ldl to become involved in the atherosclerotic process right simple that is just something that i want you to ponder over that you must have damaged or dysfunctional endothelium and i think the endothelium in our arteries is always being damaged by the high pressure but in insulin resistant pre-diabetic diabetic individuals i believe that repair process in the endothelium is broken and slowed down and that is why those people develop atherosclerosis more aggressively than people who are not diabetic or not insulin resistant”

“but in insulin resistant pre-diabetic diabetic individuals i believe that repair processing the endothelium is broken and slowed down and that is why those people develop atherosclerosis more aggressively than people who are not diabetic or not insulin resistant”

“I believe that even in normotensive individuals, there is probably some damage being done in arteries at pressures of 120 mm of mercury or higher than that when you exercise, especially at bifurcations, the branch points of the arteries. But in an individual who's insulin sensitive, I believe that your immune system, your repair system in your body will fix the damage in your arteries. In an insulin-resistant individual, that damage goes on way too long, and that is the beginning of an atherosclerotic plaque.”

“So, what happens with insulin resistance? Why is insulin resistance so critical for the development of atherosclerosis? Because insulin resistance impairs the wound healing of the damage in the arteries that is done from a higher-pressure system.”

“if you get these little micro tears in your endothelium you're not going to repair them as well because you're insulin resistant and how did you get insulin resistant because you're eating junk food right so you get micro tears we all get micro tears we all bump and skin our knees but those micro tears don't get repaired as well”

“it's that pressure in the arteries that damages the endothelium and that's what causes the beginning of atherosclerosis when the healing of the endothelium is impaired as it is when we're insulin resistant there's really no evidence that a higher pressure in arteries pushes apob particles into the sub-endothelial space”

“maybe we all get these scrapes on the inside of Our arteries but when you become metabolically unwell and we can talk about what does that you can't repair it properly and that's how something that should just be a little scab that repairs inside your arteries becomes a big zit that can rupture”

“in people who have some degree of insulin resistance they're not doing wound healing well... my hypothesis here the whole point of this discussion is to propose another theory of atherosclerosis that says wait what if LDL is not the right target because there's probably something else going on what if endothelial damage is the originator of the atherosclerotic plaque and it's only in people who are insulin resistant that that atherosclerotic plaque begins to develop because that wound healing at the level of the endothelium is not proceeding properly”