Insulin Resistance and Risk of Ischemic Stroke Among Nondiabetic Individuals From the Northern Manhattan Study

Rundek, Tatjana; Gardener, Hannah; Xu, Qiang; Goldberg, Ronald; Wright, Clinton B.; Boden‐Albala, Bernadette; Disla, Norbelina; Paik, Myunghee Cho; Elkind, Mitchell S.V.; Sacco, Ralph L.

doi:10.1001/archneurol.2010.235

Cited by 109 publications

(107 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings of a positive association between IR (as measured by HOMA‐IR) and CHD or an inverse association between insulin sensitivity (as measured by the McAuley index) and CHD are consistent with previous studies in predominantly white populations 6, 7, 8, 9. Prior studies that investigated sex differences in the association between IR and CVD found varying effects depending on which measure was used; the association was stronger in men than in women using HOMA‐IR, but the opposite was found using fasting insulin and fasting glucose 6…”

Section: Discussionsupporting

confidence: 92%

“…In the ARIC study, an association was reported between fasting insulin and stroke in whites, but not blacks 7. Although the direction of the association between HOMA‐IR and stroke in our study was similar to previous studies,7, 8, 9 we may have had limited power to explore these relationships by stroke subtypes. It is possible that because of the association between IR and pro‐atherogenic factors, it may therefore be more likely linked to ischemic stroke attributable to small or large vessel atherosclerosis than to intracerebral hemorrhage.…”

Section: Discussioncontrasting

confidence: 47%

See 1 more Smart Citation

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Effoe

Wagenknecht

Tcheugui

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundStudies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA‐IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks.Methods and Results IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA‐IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA‐IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD‐only, 58 stroke‐only, and 11 CHD/stroke) over a median follow‐up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67–0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA‐IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55–0.92 and hazard ratio 1.33, 95% CI: 1.03–1.72, respectively), but not stroke risk. The logHOMA‐IR and CHD association was present in men, but not in women (P interaction=0.01).ConclusionsBoth HOMA‐IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA‐IR and CHD association was present in men, but not in women.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 47%

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Effoe

Wagenknecht

Tcheugui

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…Previous studies focused mostly on the association of insulin resistance with the incidence of stroke in the nondiabetic general population 4, 5, 6, 7. The association between insulin resistance and prognosis of patients with ischemic stroke has rarely been studied.…”

Section: Discussionmentioning

confidence: 99%

Post–Glucose Load Measures of Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke

Pan

Jing

Chen

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundInsulin resistance is associated with an increased risk of cardiovascular events in the general population. This study aimed to estimate the association between post–glucose load measures of insulin resistance and prognosis of nondiabetic patients with ischemic stroke.Methods and ResultsData were derived from the ACROSS‐China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke without a history of diabetes mellitus were included. Two post–glucose load measures of insulin sensitivity, the insulin sensitivity indices ISI(composite) and the ISI 0,120, were calculated. Outcomes included stroke recurrence, all‐cause death, and poor functional outcome at 12 months. Among 1203 patients, 63.3% were male with an average age of 62.1 years. At 12 months, 168 (14.4%) patients had recurrent stroke, 111 (9.2%) had died, and 288 (24.4%) had poor outcome. After adjustment for potential covariates, the first quartile of the ISI(composite) was associated with increased 12‐month stroke recurrence (adjusted hazard ratio 2.02, 95% CI 1.28–3.18, P=0.003), death (adjusted hazard ratio 2.78, 95% CI 1.59–4.86, P<0.001), and poor outcome (adjusted odds ratio 2.67, 95% CI 1.69–4.21, P<0.001) compared with the fourth quartile. Similar results were observed for the ISI 0,120 but with a larger magnitude of association. Using a multivariable regression model with restricted cubic spline, we found an L‐shaped association between the insulin sensitivity indices and the risk of each end point.ConclusionsIn this large‐scale registry, post–glucose load measures of insulin resistance with the ISI(composite) and the ISI 0,120 were associated with 12‐month poor outcomes of nondiabetic patients with ischemic stroke.

show abstract

“…In the Atherosclerosis Risk in Communities study, elevated fasting insulin levels in nondiabetics was related to higher risk of stroke (relative risk, 1.19 per 50 pmol/L rise). Furthermore, among nondiabetic subjects in NOMASS, those with elevated measurements of insulin resistance were significantly more likely to have a first ischemic stroke, even after adjusting for other risk factors and the metabolic syndrome [30]. The metabolic syndrome, a constellation of glucose dysmetabolism, obesity, hypertension, and dyslipidemia has been shown to independently confer greater risk of first and recurrent stroke [31,32].…”

Section: Modifiable Medical Risk Factorsmentioning

confidence: 97%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

View full text Add to dashboard Cite

Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

show abstract

Insulin Resistance and Risk of Ischemic Stroke Among Nondiabetic Individuals From the Northern Manhattan Study

Cited by 109 publications

References 26 publications

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Post–Glucose Load Measures of Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Contact Info

Product

Resources

About