However, when a state of compensatory hyperinsulinemia occurs in IR subjects, due to changes in insulin secretion and/or insulin clearance [65], the ensuing response includes mild forms of glucose intolerance, dyslipidemia (high triglycerides, low HDL, small dense LDL), and hypertension which is the pathophysiological construct of the insulin resistance syndrome developed by Reaven leading to increased risk of CVD, as well conditions such as stroke, polycystic ovary syndrome, non-alcoholic fatty liver disease, cancer, and sleep apnea [66]. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.