| Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. | |
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MedLine Citation:
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PMID: 20937946 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Whether insulin resistance predicts ischemic stroke (IS) is still a matter of debate. OBJECTIVE: To determine the association between insulin resistance (IR) and risk of first ischemic stroke in a large, multiethnic, stroke-free cohort without diabetes. DESIGN: Prospective, population-based cohort study. SETTING: Longitudinal epidemiologic study. PARTICIPANTS: A cohort of 1509 nondiabetic participants from the Northern Manhattan Study (mean [SD] age, 11 [10] years; 64.2% women; 58.9% Hispanics). MAIN OUTCOME MEASURES: Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = [fasting insulin × fasting glucose] / 22.5). Insulin resistance was defined by a HOMA-IR index in the top quartile (Q4). Cox proportional hazards models were used to determine the effect of HOMA-IR on the risk of incident IS, myocardial infarction (MI), vascular death, and combined outcomes (IS, MI, and vascular death). RESULTS: The mean (SD) HOMA-IR was 2.3 (2.1), and Q4 was at least 2.8. During mean follow-up of 8.5 years, vascular events occurred in 180 participants; 46 had fatal or nonfatal IS, 45 had fatal or nonfatal MI, and 121 died of vascular causes. The HOMA-IR Q4 vs less than Q4 significantly predicted the risk of IS only (adjusted hazard ratio, 2.83; 95% confidence interval, 1.34-5.99) but not other vascular events. This effect was independent of sex, race/ethnicity, traditional vascular risk factors, and metabolic syndrome and its components. CONCLUSIONS: Insulin resistance estimated using the HOMA is a marker of increased risk of incident stroke in nondiabetic individuals. These findings emphasize the need to better characterize individuals at increased risk for IS and the potential role of primary preventive therapies targeted at IR. |
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Authors:
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Tatjana Rundek; Hannah Gardener; Qiang Xu; Ronald B Goldberg; Clinton B Wright; Bernadette Boden-Albala; Norbelina Disla; Myunghee C Paik; Mitchell S V Elkind; Ralph L Sacco |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Archives of neurology Volume: 67 ISSN: 1538-3687 ISO Abbreviation: Arch. Neurol. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-12 Completed Date: 2010-10-29 Revised Date: 2010-12-03 |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 1195-200 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA. trundek@med.miami.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Cohort Studies Community Health Planning Enzyme-Linked Immunosorbent Assay / methods Female Humans Insulin / blood Insulin Resistance* Male Middle Aged Myocardial Infarction / blood, epidemiology New York City / epidemiology, ethnology Retrospective Studies Risk Factors Stroke / blood, epidemiology* Vascular Diseases / blood, epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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2 M01 RR00645/RR/NCRR NIH HHS; K23 NS42912/NS/NINDS NIH HHS; R37 NS029993-17S1/NS/NINDS NIH HHS; R37 NS029993-19/NS/NINDS NIH HHS; R37/R01 29993//PHS HHS |
| Chemical | |
Reg. No./Substance:
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11061-68-0/Insulin |
| Comments/Corrections | |
Comment In:
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Arch Neurol. 2010 Oct;67(10):1177-8
[PMID:
20937943
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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