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Insulin resistance linked with increased risk for stroke in patients without diabetes
Hankey T. Arch Neurol. 2010;67:1177-1178.
Rundek T. Arch Neurol. 2010;67:1195-1200.
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Insulin resistance estimated using the homeostasis model assessment was a marker for an increased risk for incident stroke in those without diabetes, according to new study data.
Researchers of this prospective, population-based cohort study analyzed nondiabetic participants (n=1,509) from the Northern Manhattan Study (mean age, 68 ± 11 years; 62.4% women; 58.9% Hispanics). All members from this multi-ethnic urban community were free of stroke at baseline and were followed annually by telephone to determine any change in vital status, detect neurologic and cardiac symptoms and events, and review interval hospitalizations, risk factor status, medications and changes in functional status.
According to study data, the mean homeostasis model assessment (HOMA) of insulin sensitivity was 2.3 ± 2.1. During a mean follow-up of 8.5 years, one or more symptomatic vascular events were reported in 180 participants, 46 of whom had fatal or nonfatal ischemic stroke, 45 had fatal or nonfatal MI and 121 died from vascular causes. HOMA insulin resistance index in the top quartile (Q4) predicted the risk for ischemic stroke (adjusted HR=2.83; 95% CI, 1.34-5.99) when compared with less than Q4; however, this did not hold true with other vascular events.
This study, the researchers wrote, “provides evidence that insulin resistance as measured using HOMA is independently associated with an increased risk of first ischemic stroke. Insulin resistance may be a novel therapeutic target for stroke prevention. … In addition to secondary stroke prevention, future studies are needed to determine whether the treatment of insulin resistance can reduce the risk of incident stroke and CVD.”
In an accompanying editorial, Graeme J. Hankey, MD, with the School of Medicine and Pharmacology, University of Western Australia in Perth, and Tan Ze Feng, MD, from the First Affiliated Hospital of Jinan University, Guangzhou, China, said measuring insulin resistance may help refine prognostic estimates of future risk for stroke obtained by means of traditional risk stratification schemes.
“Although it is premature to widely screen for insulin resistance as a means to prevent stroke, its measurement may have a role in particular cases in which traditional risk stratification schemes suggest that the patient is at intermediate risk of stroke (rather than high or low risk) and in whom an additional finding of insulin resistance may be sufficiently compelling to supplement lifestyle advice with pharmacological interventions to lower stroke risk,” Hankey and Feng said.
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