LEP and Insulin resistance: Leptin values were markedly elevated, with most patients meeting criteria for metabolic syndrome based on leptin values, and the levels were consistent with features such as elevated body mass index and the presence of insulin resistance (elevated homeostasis model of assessment–insulin resistance indices).26 Leptin has been shown in numerous studies to represent an independent predictor of acute coronary events and stroke after controlling for concomitant risk factors.27,28 Leptin values have been previously shown to decrease in response to therapy with ACEI and/or ARB.