Insulin resistance syndrome (metabolic syndrome, syndrome X, 5HD) involves main risk factors accelerating atherothrombogenesis. Microvascular angina pectoris is also a part of syndrome (IRS), because hyperinsulinism compensating insulin resistance was found in 61.9 % of patients with microvascular angina pectoris and in 75 % of patients who have overcome myocardial infarction, and similarly in 75 % of patients with ischemic heart disease with significant coronary stenoses where insulin levels positively correlated with the quantitative coronary score. Therefore, hyperinsulinism is a significant integrating pathogenetic part or a common marker of insulin resistance in all phenomena of IRS. In the group of 500 patients indicated to coronarography 70 cases were found (14 %) that were at the end evaluated as patients with microvascular angina pectoris. Microvascular and macrovascular angina pectoris with significant coronary stenoses, if their pairs of analogical age, sex and BMI are compared, do not differ in any parameters defining insulin resistance, hyperinsulinism, obesity and dyslipoproteinaemia . However, in microvascular angina pectoris androidally obese, periclimacteric women prevailed 4.1 times. Microvascular angina pectoris is not a trivial disease, because some patients might later develop, if analogical risk factors are present, significant coronary stenoses, left Tawar`s branch blockage, dilated cardiomyopathy, though larger transmural myocardial infarctions here usually do not occur.