Jing Jing1, Yuesong Pan1, Xingquan Zhao1, Huaguang Zheng1, Qian Jia1, Donghua Mi1, Weiqi Chen1, Hao Li1, Liping Liu1, Chunxue Wang1, Yan He1, David Wang1, Yilong Wang1, Yongjun Wang2. 1. From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). 2. From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). yongjunwang1962@gmail.com yilong528@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabetic patients with first-ever acute ischemic stroke. METHODS: Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5]). RESULTS: Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53; P=0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19; P=0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95; P=0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome (P for trend =0.005, 0.005, and 0.001, respectively). CONCLUSIONS: Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabetic patients with acute ischemic stroke.
BACKGROUND AND PURPOSE:Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabeticpatients with first-ever acute ischemic stroke. METHODS:Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5]). RESULTS: Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53; P=0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19; P=0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95; P=0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome (P for trend =0.005, 0.005, and 0.001, respectively). CONCLUSIONS:Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabeticpatients with acute ischemic stroke.
Authors: Liz Simon; Diego Torres; Ari Saravia; Danielle E Levitt; Curtis Vande Stouwe; Heather McGarrah; Larry Coleman; Jason P Dufour; Angela M Amedee; Patricia E Molina Journal: Am J Physiol Regul Integr Comp Physiol Date: 2021-09-15 Impact factor: 3.210
Authors: Jeremiah Hadwen; Woojin Kim; Brian Dewar; Tim Ramsay; Alexandra Davis; Dar Dowlatshahi; Michel Shamy Journal: BMJ Open Date: 2021-03-26 Impact factor: 2.692
Authors: Stefany D Primeaux; Liz Simon; Tekeda F Ferguson; Danielle E Levitt; Meghan M Brashear; Alice Yeh; Patricia E Molina Journal: Alcohol Clin Exp Res Date: 2021-08-02 Impact factor: 3.928