§  Coronary artery disease (CAD) remains one of the leading causes of

§  morbidity and mortality worldwide.

§  Although diabetes mellitus is a well-established risk factor for CAD, a substantial proportion of non-diabetic individuals also develop premature and severe coronary atherosclerosis.

§  Increasing evidence indicates that insulin resistance (IR) plays a central role in the pathogenesis of CAD even in the absence of overt hyperglycemia.

§  Insulin resistance is characterized by reduced biological response to normal insulin levels, leading to compensatory hyperinsulinemia.

§  It acts as a pro atherogenic state where free fatty acids will be