There are many metabolic consequences of insulin resistance and multiple conditions associated with insulin resistant states. The most obvious pathology associated with insulin resistance is type 2 diabetes mellitus, but other manifestations include hypertension, central obesity, a hypercoagulable state, and dyslipidemia. The atherogenic dyslipidemia associated with insulin resistant states is characterized by hypertriglyceridemia; an increase in very-low-density lipoprotein secretion from the liver; an increase in atherogenic small, dense low-density lipoprotein; and a decrease in high-density lipoprotein cholesterol. Each of these lipid abnormalities is an independent risk factor for coronary artery disease, and in concert, the cardiovascular risk is magnified. Therefore, insulin resistant states should be identified as early as possible in patients, and these lipid abnormalities should be assessed and treated.