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Background Insulin exerted anti-inflammatory effects in ischemic/reperfused heart tissue through phosphatidylinositol3-kinase (PI3K)-Akt-dependent (PI3K-Akt) pathway, as shown in our previous studies.Toll-like receptor 4 (TLR4)signaling as a key regulator of inflammation is known to participate in the development of atherosclerosis.We hypothesized that insulin might increase the stability atherosclerotic plaques by regulating TLR4-mediated pathway.