Although hyperinsulinaemia is an independent risk factor for the development of atherosclerotic lesions [1], mechanisms underlying the atherogenetic actions of insulin are largely unclear. Recent studies have shown that insulin exerts various endothelial effects, such as an increase of endothelin-1 and nitric oxide production [2]. These findings are of particular relevance and suggest insulin might also exert other endothelial effects which, in turn, could trigger and maintain the atherogenetic process.In this context, vascular cell adhesion molecule(VCAM)-1 is an endothelial adhesin whose up regulation is the most important initiating event in atheroma formation [3]. In spite of this, whether or not insulin might influence VCAM-1 expression by the human vascular endothelium is notknown. Diabetologia (1999) Methods. Human vascular endothelial cells derived from umbilical cord veins were incubated with either insulin (from 10 ±6 to 10 ±9 mol/l) or tumour necrosis factor-a (5 ng/ml) for 6 to 24 h. Plasma soluble vascular cell adhesion molecule-1 concentrations were evaluated in 12 non-insulin-dependent diabetic patients (8 men, 4 women, mean age 47.1 ± 7.7 years) and 12 healthy volunteers matched for age, sex and weight (7 men, 5 women, mean age 42.2 ± 7.2 years) before and after a 2-h euglycaemic hyperinsulinaemic clamp. Results. Transcriptional activities of nuclear factor-kB luciferase and vascular adhesion molecule-1 luciferase statistically significantly increased after incubation with tumour necrosis factor-a. By contrast, a slight increment of nuclear factor-kB luciferase (mean: 1.8 ± 0.3 fold) but not of vascular cell adhesion molecule-1 luciferase transcriptional activities were detected in cells stimulated with insulin. Soluble vascular cell adhesion molecule-1 concentrations in cell supernatants increased after tumour necrosis factor-a but not insulin stimulation. In vivo, baseline plasma soluble vascular cell adhesion molecule-1 concentrations were higher (p = 0.03) in non-insulin-dependent patients (708.7 ± 97.4 mg/l) than controls (632.1 ± 65.2 mg/l) but were not related to fasting insulin concentrations and did not change during insulin infusion. Conclusion/interpretation. The increased concentrations of circulating soluble vascular cell adhesion molecule-1 indicates that the vascular endothelium is activated in non-insulin dependent diabetic patients. Our in vitro and in vivo findings show that vascular cell adhesion molecule-1 activation cannot be due to hyperinsulinaemia. [Diabetologia (1999