The fibrous plaques cause complication in the lesions as well as ulceration, thrombosis, hemorrhage and mineralization with resultant myocardial infarctions and strokes due to occlusion of an artery. This involves a compensatory enlargement of the coronary arteries as part of the structural and functional changes occurring in all levels of arteries. This enlargement of the diameter of the artery is also accompanied by thickening of the artery wall and plaque formation. The story doesn't stop there. Other changes associated with aging including a progressive decline in glucose tolerance and the compensatory development of hyperinsulinemia to deal with the intolerance.
Insular resistance involves peripheral tissue resistance to insulin action.
Thus, it may be that hyperinsulinemia secondary to an acquired or genetic insular resistance enhances the arteriosclerotic process. This leads to another level of this complicated and still not fully understood process. With aging, there is an increase in the total body fat usually seen as an elevated waist to hip ratio. Insulin resistance may play a role in this increased body fat and may be associated with abdominal obesity accompanying aging, rather than the aging process per se. It would appear that visceral fat accumulation is more closely associated with insulin resistance.