INS and endothelial dysfunction: Furthermore, when the balance of insulin resistance is transferred towards the MAPK/ERK pathway, insulin releases inflammatory markers such as PAI-1, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin, which leads to endothelial dysfunction, which in turn predisposes to vascular pathology [43].