Ablating insulin receptors in cardiomyocytes causes subendocardial fibrosis and left ventricular (LV) dysfunction after 4 wk of transverse aortic constriction (TAC).To determine whether these maladaptive responses are precipitated by coronary vascular dysfunction, we studied mice with cardiomyocyterestricted knock out of insulin receptors (CIRKO) and wild-type (WT) TAC mice before the onset of overt LV dysfunction. Two weeks of TAC produced comparable increases (P Ͻ 0.05 vs. respective sham) in heart weight/body weight (mg/g) in WT-TAC (8.03 Ϯ 1.14, P Ͻ 0.05 vs. respective sham) and CIRKO-TAC (7.76 Ϯ 1.25, P Ͻ 0.05 vs. respective sham) vs. WT-sham (5.64 Ϯ 0.11) and CIRKO-sham (4.64 Ϯ 0.10) mice. In addition, 2 wk of TAC were associated with similar LV geometry and function (echocardiography) and interstitial fibrosis (picrosirius red staining) in CIRKO and WT mice. Responses to acetylcholine (ACh), N G -monomethyl-L-arginine (L-NMMA), and sodium nitroprusside (SNP) were measured in coronary arteries that were precontracted to achieve ϳ70% of maximal tension development using the thromboxane A2 receptor mimetic U-46619 (ϳ3 ϫ 10 Ϫ6 M). ACh-evoked vasorelaxation was absent in WT-TAC but was present in CIRKO-TAC albeit reduced relative to sham-operated animals. L-NMMA-evoked tension development was similar in vessels from CIRKO-TAC mice but was lower (P Ͻ 0.05) in WT-TAC animals vs. the respective sham-operated groups, and SNP-evoked vasorelaxation was similar among all mice. Thus estimates of stimulated and basal endothelial nitric oxide release were better preserved in CIRKO vs. WT mice in response to 2 wk of TAC. These findings indicate that maladaptive LV remodeling previously observed in CIRKO-TAC mice is not precipitated by coronary artery dysfunction, because CIRKO mice exhibit compensatory mechanisms (e.g., increased eNOS transcript and protein) to maintain coronary endothelial function in the setting of pressure overload. nitric oxide; blood vessel; mice; cardiac hypertrophy; endotheliumdependent vasorelaxation DIABETIC PATIENTS WITH CARDIOVASCULAR disease (CVD) have a worse prognosis than nondiabetic individuals who develop CVD (7). Even when the extent of coronary artery disease and infarct size are accounted for, diabetic patients have a higher incidence of heart failure and mortality in the setting of acute coronary syndromes or revascularization procedures. Although the precise mechanism responsible for the poor outcome of diabetic patients in these situations is unclear, insulin resistance and hyperglycemia may each play significant roles.Both cardiac myocytes and vascular endothelial cells may be adversely affected by diabetes, particularly in the setting of pathological stresses such as ischemia or pressure overload. Hyperglycemia and altered insulin signaling may independently or collectively have negative consequences in the vasculature (3,5,14,21). In addition, growing evidence suggests that cardiac myocytes may affect the coronary vasculature through paracrine mechanisms (12).To elucidate the ad...