Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study

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

Research output: Contribution to journalArticle

Abstract

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 X 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.

Original languageEnglish (US)
Pages (from-to)1195-1200
Number of pages6
JournalArchives of Neurology
Volume67
Issue number10
DOIs
StatePublished - Oct 2010

Fingerprint

Insulin Resistance
Stroke
Homeostasis
Blood Vessels
Myocardial Infarction
Fasting
Manhattan
Insulin
Hispanic Americans
Proportional Hazards Models
Longitudinal Studies
Epidemiologic Studies
Cohort Studies
Outcome Assessment (Health Care)
Confidence Intervals
Glucose

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. / Rundek, Tatjana; Gardener, Hannah; Xu, Qiang; Goldberg, Ronald B.; Wright, Clinton B.; Boden-Albala, Bernadette; Disla, Norbelina; Paik, Myunghee C.; Elkind, Mitchell S V; Sacco, Ralph L.

In: Archives of Neurology, Vol. 67, No. 10, 10.2010, p. 1195-1200.

Research output: Contribution to journalArticle

Rundek, T, Gardener, H, Xu, Q, Goldberg, RB, Wright, CB, Boden-Albala, B, Disla, N, Paik, MC, Elkind, MSV & Sacco, RL 2010, 'Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study', Archives of Neurology, vol. 67, no. 10, pp. 1195-1200. https://doi.org/10.1001/archneurol.2010.235
Rundek, Tatjana ; Gardener, Hannah ; Xu, Qiang ; Goldberg, Ronald B. ; Wright, Clinton B. ; Boden-Albala, Bernadette ; Disla, Norbelina ; Paik, Myunghee C. ; Elkind, Mitchell S V ; Sacco, Ralph L. / Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. In: Archives of Neurology. 2010 ; Vol. 67, No. 10. pp. 1195-1200.
@article{1ae236932ea748c2a334d8e458290a25,
title = "Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study",
abstract = "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 X 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.",
author = "Tatjana Rundek and Hannah Gardener and Qiang Xu and Goldberg, {Ronald B.} and Wright, {Clinton B.} and Bernadette Boden-Albala and Norbelina Disla and Paik, {Myunghee C.} and Elkind, {Mitchell S V} and Sacco, {Ralph L.}",
year = "2010",
month = "10",
doi = "10.1001/archneurol.2010.235",
language = "English (US)",
volume = "67",
pages = "1195--1200",
journal = "Archives of Neurology",
issn = "0003-9942",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study

AU - Rundek, Tatjana

AU - Gardener, Hannah

AU - Xu, Qiang

AU - Goldberg, Ronald B.

AU - Wright, Clinton B.

AU - Boden-Albala, Bernadette

AU - Disla, Norbelina

AU - Paik, Myunghee C.

AU - Elkind, Mitchell S V

AU - Sacco, Ralph L.

PY - 2010/10

Y1 - 2010/10

N2 - 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 X 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.

AB - 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 X 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.

UR - http://www.scopus.com/inward/record.url?scp=77957948542&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957948542&partnerID=8YFLogxK

U2 - 10.1001/archneurol.2010.235

DO - 10.1001/archneurol.2010.235

M3 - Article

VL - 67

SP - 1195

EP - 1200

JO - Archives of Neurology

JF - Archives of Neurology

SN - 0003-9942

IS - 10

ER -