Obesity and type 2 diabetes are associated with chronic hyperinsulinemia, elevated plasma levels of dipeptidyl peptidase-4 (DPP4), and a pro-atherosclerotic milieu.PubMed search of the term "insulin and atherosclerosis", "hyperinsulinemia", "atherosclerosis" or "cardiovascular outcomes" cross-referenced with "DPP4". Relevant research and review articles were reviewed.DPP4 may represent a key link between central obesity, insulin resistance, and atherosclerosis. The gaps in knowledge in DPP4 function and discrepancy in cardiovascular outcomes observed in pre-clinical and large scale randomized controlled studies with DPP4 inhibitors warrant additional research.

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