Tetsuro Ago1, Ryu Matsuo1, Jun Hata1, Yoshinobu Wakisaka1, Junya Kuroda1, Takanari Kitazono1, Masahiro Kamouchi2. 1. From the Departments of Medicine and Clinical Science (T.A., R.M., J.H., Y.W., J.K., T.K.), Health Care Administration and Management (R.M., M.K.), and Epidemiology and Public Health (J.H.), and the Center for Cohort Studies (J.H., Y.W., T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. From the Departments of Medicine and Clinical Science (T.A., R.M., J.H., Y.W., J.K., T.K.), Health Care Administration and Management (R.M., M.K.), and Epidemiology and Public Health (J.H.), and the Center for Cohort Studies (J.H., Y.W., T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kamouchi@hcam.med.kyushu-u.ac.jp.
Abstract
OBJECTIVE: In this study, we aimed to determine whether insulin resistance is associated with clinical outcomes after acute ischemic stroke. METHODS: We enrolled 4,655 patients with acute ischemic stroke (aged 70.3 ± 12.5 years, 63.5% men) who had been independent before admission; were hospitalized in 7 stroke centers in Fukuoka, Japan, from April 2009 to March 2015; and received no insulin therapy during hospitalization. The homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated using fasting blood glucose and insulin levels measured 8.3 ± 7.8 days after onset. Study outcomes were neurologic improvement (≥4-point decrease in NIH Stroke Scale score or 0 at discharge), poor functional outcome (modified Rankin Scale score of ≥3 at 3 months), and 3-month prognosis (stroke recurrence and all-cause mortality). Logistic regression analysis was used to evaluate the association of the HOMA-IR score with clinical outcomes. RESULTS: The HOMA-IR score was associated with neurologic improvement (odds ratio, 0.68 [95% confidence interval, 0.56-0.83], top vs bottom quintile) and with poor functional outcome (2.02 [1.52-2.68], top vs bottom quintile) after adjusting for potential confounding factors, including diabetes and body mass index. HOMA-IR was not associated with stroke recurrence or mortality within 3 months of onset. The associations were maintained in nondiabetic or nonobese patients. No heterogeneity was observed according to age, sex, stroke subtype, or stroke severity. CONCLUSIONS: These findings suggest that insulin resistance is independently associated with poor functional outcome after acute ischemic stroke apart from the risk of short-term stroke recurrence or mortality.
OBJECTIVE: In this study, we aimed to determine whether insulin resistance is associated with clinical outcomes after acute ischemic stroke. METHODS: We enrolled 4,655 patients with acute ischemic stroke (aged 70.3 ± 12.5 years, 63.5% men) who had been independent before admission; were hospitalized in 7 stroke centers in Fukuoka, Japan, from April 2009 to March 2015; and received no insulin therapy during hospitalization. The homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated using fasting blood glucose and insulin levels measured 8.3 ± 7.8 days after onset. Study outcomes were neurologic improvement (≥4-point decrease in NIH Stroke Scale score or 0 at discharge), poor functional outcome (modified Rankin Scale score of ≥3 at 3 months), and 3-month prognosis (stroke recurrence and all-cause mortality). Logistic regression analysis was used to evaluate the association of the HOMA-IR score with clinical outcomes. RESULTS: The HOMA-IR score was associated with neurologic improvement (odds ratio, 0.68 [95% confidence interval, 0.56-0.83], top vs bottom quintile) and with poor functional outcome (2.02 [1.52-2.68], top vs bottom quintile) after adjusting for potential confounding factors, including diabetes and body mass index. HOMA-IR was not associated with stroke recurrence or mortality within 3 months of onset. The associations were maintained in nondiabetic or nonobese patients. No heterogeneity was observed according to age, sex, stroke subtype, or stroke severity. CONCLUSIONS: These findings suggest that insulin resistance is independently associated with poor functional outcome after acute ischemic stroke apart from the risk of short-term stroke recurrence or mortality.
Authors: Laura Ibanez; Laura Heitsch; Umber Dube; Fabiana H G Farias; John Budde; Kristy Bergmann; Rich Davenport; Joseph Bradley; Caty Carrera; Janne Kinnunen; Hanne Sallinen; Daniel Strbian; Agnieszka Slowik; Israel Fernandez-Cadenas; Joan Montaner; Jin-Moo Lee; Carlos Cruchaga Journal: Stroke Date: 2019-05-14 Impact factor: 7.914
Authors: Edna Maria Vissoci Reiche; Jair Roberto Gelinksi; Daniela Frizon Alfieri; Tamires Flauzino; Marcio Francisco Lehmann; Maria Caroline Martins de Araújo; Marcell Alysson Batisti Lozovoy; Andrea Name Colado Simão; Elaine Regina Delicato de Almeida; Michael Maes Journal: Metab Brain Dis Date: 2019-03-14 Impact factor: 3.584