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Zhou M, Mei L, Jing J, Yang Y, Cai X, Meng X, Jin A, Lin J, Li S, Li H, Wei T, Wang Y, Wang Y, Pan Y. Blood Pressure Partially Mediated the Association of Insulin Resistance and Cerebral Small Vessel Disease: A Community-Based Study. J Am Heart Assoc 2024; 13:e031723. [PMID: 38390815 PMCID: PMC10944068 DOI: 10.1161/jaha.123.031723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Insulin resistance as a significant vascular risk factor has been studied in relation to cerebral small vessel disease (SVD). Evidence suggests that insulin resistance might trigger high blood pressure (BP). Therefore, we aimed to investigate whether insulin resistance impacts SVD with a mediating effect of BP in nondiabetic subjects. METHODS AND RESULTS PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study participants underwent brain and vascular imaging techniques and metabolomic risk factors measurements. Insulin resistance was evaluated by the insulin sensitivity index and the Homeostatic Model Assessment for Insulin Resistance based on the standard oral glucose tolerance test. On average, 2752 nondiabetic subjects (47.1% men) aged 60.9 years were included. The multivariable logistic regression model and linear regression model tested the association of insulin resistance with BP components (including systolic BP [SBP], diastolic BP (DBP), and pulse pressure [PP]) and SVD, and of BP components with SVD. In the mediation analysis, SBP, DBP, and PP were found to partially mediate the detrimental effect of insulin resistance (assessed by the insulin sensitivity index) on lacunes (mediation percentage: SBP, 31.15%; DBP, 34.21%; PP, 10.43%), white matter hyperintensity (mediation percentage: SBP, 37.34%; DBP, 44.15%; PP, 9.80%), and SVD total burden (mediation percentage: SBP, 42.07%; DBP, 49.29%; PP, 11.71%) (all P<0.05). The mediation analysis results were not significant when using the Homeostatic Model Assessment for Insulin Resistance to assess insulin resistance. CONCLUSIONS Higher insulin resistance was associated with SVD in this community-dwelling population. The association of insulin resistance with lacunes, white matter hyperintensity, and SVD total burden was explained in part by BP. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03178448.
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Affiliation(s)
- Mengyuan Zhou
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui HospitalZhejiang University School of MedicineLishuiChina
| | - Jing Jing
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yingying Yang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xueli Cai
- Department of NeurologyLishui Hospital, Zhejiang University School of MedicineLishuiChina
| | - Xia Meng
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Aoming Jin
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jinxi Lin
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Shan Li
- Cerebrovascular Research Lab, Lishui HospitalZhejiang University School of MedicineLishuiChina
| | - Hao Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Tiemin Wei
- Department of Cardiology, Lishui HospitalZhejiang University School of MedicineLishuiChina
| | - Yongjun Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- National Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Yilong Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- National Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- Beijing Laboratory of Oral HealthCapital Medical UniversityBeijingChina
| | - Yuesong Pan
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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Jin A, Wang S, Li J, Wang M, Lin J, Li H, Meng X, Wang Y, Pan Y. Mediation of Systemic Inflammation on Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke. Stroke 2023; 54:759-769. [PMID: 36722344 DOI: 10.1161/strokeaha.122.039542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Insulin resistance is associated with stroke recurrence and poor functional outcomes of nondiabetic patients with ischemic stroke. The study aimed to investigate whether the association between insulin resistance and the prognosis of nondiabetic patients with ischemic stroke was mediated by systematic inflammation. METHODS Patients with ischemic stroke but without a history of diabetes who were enrolled in CNSR-III (Third China National Stroke Registry) were included in the study and followed up for 1 year after stroke onset. Insulin resistance was determined by using the homeostasis model assessment for insulin resistance (HOMA-IR) method. hs-CRP (high-sensitivity C-reactive protein) and Lp-PLA2 (lipoprotein-associated phospholipase A2) activity were measured at baseline. The primary outcome was stroke recurrence, and other outcomes included composite vascular events, mortality, and poor functional outcome (modified Rankin Scale score, 3-6). Multivariable Cox or logistic regression analyses were performed to estimate the association between HOMA-IR and the study outcomes. A mediation analysis was performed to examine the relationship between insulin resistance and the study outcomes mediated by systemic inflammation. RESULTS Among a total of 3808 nondiabetic patients with ischemic stroke who were included in the study, the median HOMA-IR was 1.79 (interquartile range, 1.05-2.97). After adjustments for potential confounders, higher HOMA-IR quartiles were associated with higher risks of stroke recurrence, ischemic stroke, and composite vascular events, especially in the large artery atherosclerosis subtype. hs-CRP partially mediated the association between the HOMA-IR index and the prognosis of ischemic stroke (mediation proportion, 5.9% for stroke recurrence and 7.5% for composite vascular events). No evidence of Lp-PLA2 activity mediating the association of insulin resistance with stroke outcomes was observed. CONCLUSIONS Our study found that insulin resistance was associated with poor clinical outcomes in nondiabetic patients with ischemic stroke, which was partially mediated by hs-CRP with a modest amount.
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Affiliation(s)
- Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Shukun Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, China (S.W.)
| | - Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,Advanced Innovation Center for Human Brain Protection (Y.W.), Capital Medical University, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease (Y.W.), Chinese Academy of Sciences, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
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Effects of a yoga-based stress reduction intervention on stress, psychological outcomes and cardiometabolic biomarkers in cancer caregivers: A randomized controlled trial. PLoS One 2022; 17:e0277009. [DOI: 10.1371/journal.pone.0277009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
Abstract
Caregiving stress is a risk factor for cardiometabolic disease. Therefore, integrating cardiometabolic biomarkers into caregiving research provides a more comprehensive assessment of an individual’s health and response to an intervention. The objective of this study was to examine the effects of a yoga-based stress reduction intervention on stress, psychological outcomes, and cardiometabolic biomarkers in cancer caregivers. This prospective randomized controlled trial enrolled family caregivers of adult patients who underwent an allogeneic HSCT at the National Institutes of Health (NIH) Clinical Center. All subjects received usual care education. Participants in the intervention group received an Iyengar yoga intervention self-administered over six weeks using an audio recording file. The primary outcome was perceived stress (measured using the NIH toolbox Perceived Stress). The secondary outcomes were psychological factors (depression and anxiety measured using PROMIS® Depression and Anxiety), and cardiometabolic biomarkers measured by nuclear magnetic resonance spectroscopy. A total of 50 family caregivers (mean [SD] age, 44.9 [15.2] years; 42 [84.0%] women) were randomized, 25 to the intervention group and 25 to the control group. No group differences were noted in stress, depression, and anxiety. Significant interaction effects between group and time were found in large TRL-P (F(1,43) = 10.16, p = 0.003) and LP-IR (F(1,42) = 4.28, p = 0.045). Post-hoc analyses revealed that the levels of large TRL-P (mean difference = 1.68, CI = [0.86, 2.51], p< .001) and LP-IR (mean difference = 5.67, CI = [1.15, 10.18], p = 0.015) significantly increased over time in the control group but while remained stable in the intervention group (mean difference = -0.15, CI = [-0.96, 0.66], p = 0.718; mean difference = -0.81, CI = [-5.22, 3.61], p = 0.714, respectively). Even when perceptions of psychological distress remain unchanged, incorporating gentle yoga poses and breathing exercises may reduce the risk of cardiometabolic disease in caregivers by inhibiting the development of insulin resistance. Standard lipids of cardiometabolic risk do not appear to be robust enough to detect short-term early changes of cardiometabolic risk in caregivers.
Trial registration: ClinicalTrials.gov Identifier: NCT02257853.
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Zhou M, Wang S, Jing J, Yang Y, Cai X, Meng X, Mei L, Lin J, Li S, Li H, Wei T, Wang Y, Pan Y, Wang Y. Insulin resistance based on postglucose load measure is associated with prevalence and burden of cerebral small vessel disease. BMJ Open Diabetes Res Care 2022; 10:10/5/e002897. [PMID: 36220196 PMCID: PMC9557259 DOI: 10.1136/bmjdrc-2022-002897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Cerebral small vessel disease (cSVD) is highly prevalent and results in irreversible cognitive impairment and reduced quality of life. Previous studies reported controversial associations between insulin resistance and cSVD. Here, we estimated the association between insulin resistance and cSVD in non-diabetic communities in southeastern China. RESEARCH DESIGN AND METHODS The Polyvascular Evaluation for Cognitive Impairment and Vascular Events study (NCT03178448) recruited 3670 community-dwelling adults. We estimated the association of insulin resistance, assessed by the insulin sensitivity index (ISI0,120) and the homeostatic model assessment for insulin resistance (HOMA-IR) based on the standard oral glucose tolerance test, with cSVD in those without a history of diabetes mellitus. cSVD was measured for both main neuroimaging manifestations of cSVD and total SVD burden scores. RESULTS A total of 2752 subjects were enrolled. In the multivariable logistic regression analysis, the first quartile of ISI0,120 was found to be potentially associated with an increased risk of lacunes (OR 1.96, 95% CI 1.15 to 3.36), severe age-related white matter changes (OR 1.97, 95% CI 1.15 to 3.38), and higher total SVD burden (4-point scale: common OR (cOR) 1.34, 95% CI 1.04 to 1.72; 6-point scale: cOR 1.43, 95% CI 1.14 to 1.79). The associations between HOMA-IR and lacunes (OR 1.90, 95% CI 1.11 to 3.25) and the 4-point scale of total SVD burden (cOR 1.33, 95% CI 1.04 to 1.70) were also significant after adjustment for age, gender, medical history, and medications. However, the associations were not statistically significant after further adjustment for blood pressure/hypertension and body mass index (BMI). CONCLUSIONS A potential association was found between insulin resistance and cSVD, and the ISI0,120 index presented a greater association with increased risk of cSVD as compared with the HOMA-IR. However, these associations were greatly influenced by blood pressure and BMI.
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Affiliation(s)
- Mengyuan Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- National Center for Neurological Diseases, Beijing, China
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Zhou M, Li H, Wang Y, Pan Y, Wang Y. Causal effect of insulin resistance on small vessel stroke and Alzheimer's disease: A Mendelian randomization analysis. Eur J Neurol 2021; 29:698-706. [PMID: 34797599 DOI: 10.1111/ene.15190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The causal effect of insulin resistance on small vessel stroke and Alzheimer's disease (AD) was controversial in previous studies. We therefore applied Mendelian randomization (MR) analyses to identify the causal effect of insulin resistance on small vessel stroke and AD. METHODS We selected 12 single-nucleotide polymorphisms (SNPs) associated with fasting insulin levels and five SNPs associated with "gold standard" measures of insulin resistance as instrumental variables in MR analyses. Summary statistical data on SNP-small vessel stroke and on SNP-AD associations were derived from studies by the Multi-ancestry Genome-Wide Association Study of Stroke consortium (MEGASTROKE) and the Psychiatric Genomics Consortium-Alzheimer Disease Workgroup (PGC-ALZ) in individuals of European ancestry. Two-sample MR estimates were conducted with inverse-variance-weighted, robust inverse-variance-weighted, simple median, weighted median, weighted mode-based estimator, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. RESULTS Genetically predicted higher insulin resistance had a higher odds ratio (OR) of small vessel stroke (OR 1.23, 95% confidence interval [CI] 1.05-1.44, p = 0.01 using fasting insulin; OR 1.25, 95% CI 1.07-1.46, p = 0.006 using gold standard measures of insulin resistance) and AD (OR 1.13, 95% CI 1.04-1.23, p = 0.004 using fasting insulin; OR 1.02, 95% CI 1.00-1.03, p = 0.03 using gold standard measures of insulin resistance) using the inverse-variance-weighted method. No evidence of pleiotropy was found using MR-Egger regression. CONCLUSION Our findings provide genetic support for a potential causal effect of insulin resistance on small vessel stroke and AD.
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Affiliation(s)
- Mengyuan Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Oe M, Fujihara K, Harada-Yamada M, Osawa T, Kitazawa M, Matsubayashi Y, Sato T, Yaguchi Y, Iwanaga M, Seida H, Yamada T, Sone H. Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese. Cardiovasc Diabetol 2021; 20:174. [PMID: 34479567 PMCID: PMC8417951 DOI: 10.1186/s12933-021-01367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. METHODS This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. RESULTS Participants' mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI 5.97-9.17; diabetes: HR, 5.73, 95% CI 4.52-7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. CONCLUSIONS Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.
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Affiliation(s)
- Momoko Oe
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
- Kowa Company. Ltd, 10-4 Nihonbashi-honcho 3-chome, Chuo-ku, Tokyo, 103-0023, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
| | - Mayuko Harada-Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Midori Iwanaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hiroyasu Seida
- JMDC Inc, 2-5-5 Shiba Daimon, Minato-ku, Tokyo, 105-0012, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1021] [Impact Index Per Article: 340.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zhao Y, Sun H, Zhang W, Xi Y, Shi X, Yang Y, Lu J, Zhang M, Sun L, Hu D. Elevated triglyceride-glucose index predicts risk of incident ischaemic stroke: The Rural Chinese cohort study. DIABETES & METABOLISM 2021; 47:101246. [PMID: 33722769 DOI: 10.1016/j.diabet.2021.101246] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 01/23/2023]
Abstract
AIM As the association between insulin resistance and ischaemic stroke is conflicting, our study aimed to examine the association between triglyceride-glucose (TyG), a surrogate marker of insulin resistance, and incident ischaemic stroke, and also to further assess the potential effect of modification by several known risk factors of stroke. METHODS The Rural Chinese Cohort Study enrolled 11,777 participants, aged ≥40 years, who were free of stroke and cardiovascular disease at baseline during 2007-2008, and who were then followed during 2013-2014. TyG was determined using the following formula: Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The relative risk (RR) and 95% confidence interval (CI) of incident ischaemic stroke associated with TyG were estimated using modified Poisson regression models. RESULTS During a median follow-up duration of 6 years, 677 new ischaemic stroke cases were identified. After multivariate adjustment, RR (95% CI) values for ischaemic stroke were 1.33 (1.01-1.75), 1.57 (1.17-2.10) and 1.95 (1.34-2.82) in TyG quartile (Q) 2, 3 and 4 groups, respectively, compared with Q1. A significant interaction between TyG index and age for risk of ischaemic stroke (Pinteraction < 0.001) was also observed. However, no significant interaction was found between TyG index and other potential risk factors of risk for ischaemic stroke, although there were significant positive associations with female, non-smoker, non-drinker, low or moderate physical activity, non-obese and non-type 2 diabetes mellitus groups. CONCLUSION Elevated TyG index is an independent predictor of ischaemic stroke in the general population, and insulin resistance may be positively associated with future stroke risk.
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Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haohang Sun
- Cardiovascular Department, Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou, Henan, People's Republic of China
| | - Weidong Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuanlin Xi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Liang Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
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9
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Jia W, Jia Q, Zhang Y, Zhao X, Wang Y. Association between insulin resistance and aspirin or clopidogrel resistance in Chinese patients with recent ischemic stroke/TIA. Neurol Res 2021; 43:406-411. [PMID: 33455562 DOI: 10.1080/01616412.2020.1866371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: This study aims to discover whether insulin resistance is an independent predictor for antiplatelet drug resistance in patients with ischemic cerebrovascular disease.Methods: This study used a prospective cohort method. Patients diagnosed as minor ischemic stroke or transient ischemic attack (TIA) were enrolled successively. All patients have been administrated aspirin and/or clopidogrel and were tested for fasting glucose and insulin and platelet aggregation inhibition tests which was detected by light transmission aggregometry (LTA). The maximum platelet aggregation rate (AA) of ≥20% or the maximum platelet aggregation rate (ADP) of ≥50% was defined as antiplatelet drug resistance. Multivariable logistic regression was performed to estimate the association between HOMA-IR and antiplatelet drug resistance.Results: This study recruited successively 237 patients with mild-to-moderate ischemic stroke or TIA in Beijing Tiantan Hospital from 2018 to 2019. Of them 60 cases were recognized as having insulin resistance. There are 46 patients in insulin resistance group (76.7%) developed antiplatelet drug resistance, which was significantly more frequent than patients without insulin resistance (35%, P < 0.0001). Insulin resistance was an independent risk factor for antiplatelet drug resistance in patients with recent ischemic stroke/TIA after adjusted for confounding factors (Odds Ratio 5.281; 95%CI, 2.15 to 13.01, P < 0.0001).Conclusions: Insulin resistance was an independent predictor for development of antiplatelet drug resistance in patients with recent minor ischemic stroke or TIA. More attention should be paid to recognize these patients and antithrombotic effect should be monitored when antiplatelet drugs were applied to these patients.
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Affiliation(s)
- Weili Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of neurology, China National Clinical Research Center for Neurological Diseases, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of neurology, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of neurology, China National Clinical Research Center for Neurological Diseases, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of neurology, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Yumei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of neurology, China National Clinical Research Center for Neurological Diseases, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of neurology, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China.,Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of neurology, China National Clinical Research Center for Neurological Diseases, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of neurology, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of neurology, China National Clinical Research Center for Neurological Diseases, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of neurology, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
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10
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Gu T, Yang Q, Ying G, Jin B. Lack of association between insulin resistance as estimated by homeostasis model assessment and stroke risk: A systematic review and meta-analysis. Med Hypotheses 2020; 141:109700. [DOI: 10.1016/j.mehy.2020.109700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 01/21/2023]
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11
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Zhou Y, Pan Y, Yan H, Wang Y, Li Z, Zhao X, Li H, Meng X, Wang C, Liu L, Wang Y. Triglyceride Glucose Index and Prognosis of Patients With Ischemic Stroke. Front Neurol 2020; 11:456. [PMID: 32587566 PMCID: PMC7297915 DOI: 10.3389/fneur.2020.00456] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The triglyceride glucose index (TyG index) has been proposed as a simple and credible surrogate marker of insulin resistance. However, it is unclear whether TyG index correlates with adverse clinical outcomes in patients with ischemic stroke. Accordingly, this study aimed to explore the relationship between baseline TyG index and clinical outcomes of ischemic stroke individuals. Methods: We included eligible subjects with ischemic stroke from the China National Stroke Registry II for the current analysis. TyG index was calculated and divided into quartiles to explore the relationship with the outcomes of ischemic stroke. Outcomes included stroke recurrence, all-cause mortality, poor functional outcome at 12 months, and neurologic worsening at discharge. Multivariable Cox regression and logistic regression models were performed to explore the correlation of baseline TyG index with the outcomes. Results: Among the 16,310 patients enrolled in the study, the average age was 64.83 ± 11.9 years, and 63.48% were men. The median TyG index was 8.73 (interquartile range, 8.33-9.21). After adjustment for multiple potential covariates, the fourth quartile of TyG index was associated with an increased risk of stroke recurrence (adjusted HR, 1.32; 95% CI, 1.11-1.57; P = 0.002), all-cause mortality (adjusted HR, 1.25; 95%CI, 1.06-1.47; P = 0.01) at 12-month follow-up, and neurological worsening (adjusted OR, 1.26; 95% CI, 1.02-1.55; P = 0.03) at discharge, but not poor functional outcome compared with the first quartile. Conclusion: TyG index representing insulin resistance was associated with an increased risk of stroke recurrence, all-cause mortality, and neurologic worsening in patients with ischemic stroke.
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Affiliation(s)
- Yimo Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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12
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Ji A, Lou H, Lou P, Xu C, Zhang P, Qiao C, Yang Q. Interactive effect of sleep duration and sleep quality on risk of stroke: An 8-year follow-up study in China. Sci Rep 2020; 10:8690. [PMID: 32457400 PMCID: PMC7250859 DOI: 10.1038/s41598-020-65611-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Inappropriate sleep duration and poor sleep quality are associated with risk of stroke, but their interactive effect on stroke is unknown. We explored the interactive effect of sleep quality and duration on stroke risk. A prospective cohort study was conducted with 41,786 adults. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sleep duration was measured by average hours of sleep per night. Cox regression models were used to calculate the association of sleep duration and quality with stroke. The delta method and a non-conditional logistic regression model were used and the relative excess risk due to interaction (RERI), the attributable proportion (AP), and the synergy index (S) were calculated. Compared with sleep duration 6-8 h/day, the risk ratio of stroke was 1.63 (1.23-2.11) times for sleep duration <6 h/day and 1.40 (1.08-1.75) times for >8 h/day. The stroke risk ratio was 2.37 (1.52-3.41) times in subjects with poor sleep quality compared with those with good sleep quality. Women who slept <6 h/day had higher stroke risk than men who slept <6 h/day. Men who slept >8 h/day had higher stroke risk than women who slept >8 h/day. Men with poor sleep quality had higher stroke risk than women with poor sleep quality. Stroke was associated with short/long sleep duration and poor sleep quality in subjects aged >46 years, compared with those aged 18-45 years. Stroke occurred more frequently in subjects with poor sleep quality combined with short sleep duration (odds ratio: 6.75; 95% confidence interval (CI): 2.45-14.12). RERI, AP, and S values (and their 95% CIs) were 5.54 (3.75-8.12), 0.72 (0.56-0.80), and 5.69 (4.23-9.90) for the poor sleep quality interact with short sleep duration. In persons with poor sleep quality accompanied by long sleep duration, RERI, AP, and S (95% CI) were 1.12 (1.01-1.27), 0.35 (0.26-0.51), and 2.05 (1.57-2.96), respectively. Subjective sleep disturbances are related with risk of stroke in Chinese adults. There are additive interactions between short/long sleep duration and poor sleep quality that affect risk of stroke.
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Affiliation(s)
- Ailing Ji
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
| | - Heqing Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China.
| | - Chunrong Xu
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Qing Yang
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
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13
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Chen W, Wang S, Lv W, Pan Y. Causal associations of insulin resistance with coronary artery disease and ischemic stroke: a Mendelian randomization analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001217. [PMID: 32398352 PMCID: PMC7223029 DOI: 10.1136/bmjdrc-2020-001217] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The relationship between insulin resistance (IR) and cardiovascular diseases is unclear. We aimed to examine the causal associations of IR with cardiovascular diseases, including coronary artery disease, myocardial infarction, ischemic stroke and its subtypes, using Mendelian randomization. RESEARCH DESIGN AND METHODS Due to low sample size for gold standard measures and in order to well reflect the underlying phenotype of IR, we used 53 single nucleotide polymorphisms associated with IR phenotypes (ie, fasting insulin, high-density lipoprotein cholesterol and triglycerides) from recent genome-wide association studies (GWASs) as instrumental variables. Summary-level data from four GWASs of European individuals were used. Data on IR phenotypes were obtained from meta-analysis of GWASs of up to 188 577 individuals and data on the outcomes from GWASs of up to 446 696 individuals. Mendelian randomization (MR) estimates were calculated with inverse-variance weighted, simple and weighted-median approaches and MR-Egger regression was used to explore pleiotropy. RESULTS Genetically predicted 1-SD increase in IR phenotypes were associated with a substantial increase in risk of coronary artery disease (OR=1.79, 95% CI: 1.57 to 2.04, p<0.001), myocardial infarction (OR=1.78, 95% CI: 1.54 to 2.06, p<0.001), ischemic stroke (OR=1.21, 95% CI: 1.05 to 1.40, p=0.007) and the small-artery occlusion subtype of stroke (OR=1.80, 95% CI: 1.30 to 2.49, p<0.001), but not associated with the large-artery atherosclerosis and cardioembolism subtypes of stroke. There was no evidence of pleiotropy. Results were broadly consistent in sensitivity analyses using simple and weighted-median approaches accounting for potential genetic pleiotropy. CONCLUSIONS This study provides evidence to support that IR was causally associated with risk of coronary artery disease, myocardial infarction, ischemic stroke and the small-artery occlusion subtype of stroke.
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Affiliation(s)
- Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shukun Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Wei Lv
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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14
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Wu D, Yang X, Zhong P, Ye X, Li C, Liu X. Insulin Resistance Is Independently Associated With Enlarged Perivascular Space in the Basal Ganglia in Nondiabetic Healthy Elderly Population. Am J Alzheimers Dis Other Demen 2020; 35:1533317520912126. [PMID: 32180437 PMCID: PMC10624068 DOI: 10.1177/1533317520912126] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the association between insulin resistance (IR) and enlarged perivascular space (EPVS) in the basal gangliain nondiabetic healthy elderly population. METHODS A total of 235 nondiabetic healthy elderly population were recruited. A 3-level scale was used to evaluate the burden of EPVSs. The homeostasis model assessment-estimated insulin resistance index (HOMA-IR) was used for IR estimation. Correlation between IR and severity of EPVS was assessed using the regression model after adjusting demographics and cardiovascular risk factors. RESULTS The top quartile of HOMA-IR was 2.52, and 25.11% of patients showed IR. The proportion of patients with IR was higher in the moderate to severe EPVS group than in the mild group (36.51% vs 20.93%, P = .015). In multivariate logistic analysis, IR was positively correlated with the moderate to severe EPVS (adjusted odds ratio: 3.532, 95% confidence interval: 1.633-7.636, P = .001) after adjusting classical risk factors. CONCLUSIONS Insulin resistance was independently correlated with EPVS in the basal ganglia in nondiabetic healthy elderly population.
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Affiliation(s)
- Danhong Wu
- Department of Neurology, Shanghai Tenth People’s Hospital of Nanjing Medical University, Shanghai, People’s Republic of China
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoli Yang
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ping Zhong
- Shanghai Traditional Chinese and Western Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaofei Ye
- Department of Health Statistics, The Chinese People’s Liberation Navy Medical College, Shanghai, People’s Republic of China
| | - Chen Li
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People’s Hospital of Nanjing Medical University, Shanghai, People’s Republic of China
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15
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Coppola T, Beraud-Dufour S, Lebrun P, Blondeau N. Bridging the Gap Between Diabetes and Stroke in Search of High Clinical Relevance Therapeutic Targets. Neuromolecular Med 2019; 21:432-444. [PMID: 31489567 DOI: 10.1007/s12017-019-08563-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022]
Abstract
Diabetes affects more than 425 million people worldwide, a scale approaching pandemic proportion. Diabetes represents a major risk factor for stroke, and therefore is actively addressed for stroke prevention. However, how diabetes affects stroke severity has not yet been extensively considered, which is surprising given the evident but understudied common mechanistic features of both pathologies. The increase in number of diabetic people, incidence of stroke in the presence of this specific risk factor, and the exacerbation of ischemic brain damage in diabetic conditions (at least in animal models) warrants the need to integrate this comorbidity in preclinical studies of brain ischemia to develop novel therapeutic approaches. Therefore, a better understanding of the commonalties involved in the course of both diseases would offer the promise of discovering novel neuroprotective pathways that would be more appropriated to clinical scenarios. In this article, we will review the relevant mechanisms that have been identified as common traits of both pathologies and that could be, to our knowledge, potential targets in both pathologies.
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Affiliation(s)
- Thierry Coppola
- Université Côte d'Azur, CNRS, IPMC, 660 route des Lucioles, 06560, Valbonne, France.
| | - Sophie Beraud-Dufour
- Université Côte d'Azur, CNRS, IPMC, 660 route des Lucioles, 06560, Valbonne, France
| | - Patricia Lebrun
- Université Côte d'Azur, CNRS, IPMC, 660 route des Lucioles, 06560, Valbonne, France
| | - Nicolas Blondeau
- Université Côte d'Azur, CNRS, IPMC, 660 route des Lucioles, 06560, Valbonne, France.
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Xu J, Wang A, Meng X, Jing J, Wang Y, Wang Y. Obesity-Stroke Paradox Exists in Insulin-Resistant Patients But Not Insulin Sensitive Patients. Stroke 2019; 50:1423-1429. [PMID: 31043152 DOI: 10.1161/strokeaha.118.023817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose- The underlying mechanisms of stroke-obesity paradox are still not fully understood. This study aims to investigate the contribution of insulin resistance to the association between body mass index and stroke outcomes. Methods- Patients with ischemic stroke without history of diabetes mellitus in the Abnormal Glucose Regulation in Patients With Acute Stroke Across-China registry were included. Overweight or obese was defined as body mass index ≥23, and the median of homeostasis model assessment-insulin resistance index was chosen as cutoff to define insulin resistance. Cox or logistic regression model was used to assess the interaction between body mass index and homeostasis model assessment-insulin resistance on 1-year prognosis (all-cause mortality and poor functional outcome defined as modified Rankin Scale score 3-6). Results- Of 1227 study participants, the median homeostasis model assessment-insulin resistance was 1.9 (interquartile range, 1.1-3.1) and 863 (70.3%) patients were classified as overweight or obese. Among insulin-resistant patients, overweight/obese patients experienced one-half of the risk of death after stroke than their low/normal weight counterparts (9.42% versus 17.69%, unadjusted hazard ratio, 0.50; 95% CI, 0.31-0.82), while among insulin-sensitive ones, no significant difference of mortality risk was found (7.58% versus 6.91%, 1.07; 0.57-1.99). Similar trends were observed for poor functional outcome. Results were similar after adjustments for confounders. There were significant interactions between body mass index and homeostasis model assessment-insulin resistance on the risks of mortality (P=0.045) and poor functional outcome (P=0.049). Conclusions- We observed the obesity paradox for mortality and functional outcome in insulin-resistant patients but did not find the obesity paradox in insulin-sensitive patients. Insulin resistance may be one of the mechanisms underlying the obesity paradox of the outcome in patients with ischemic stroke.
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Affiliation(s)
- Jie Xu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
| | - Anxin Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
| | - Jing Jing
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- China National Clinical Research Center for Neurological Diseases, Beijing (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Center of Stroke, Beijing Institute for Brain Disorders, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.X., A.W., X.M., J.J., Yilong Wang, Yongjun Wang)
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17
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Zhou X, Zhang D, Zhou Y, Wang F, Zhu X. Microembolic Signals is Associated With Insulin Resistance Among Acute Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:1070-1077. [PMID: 30638939 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/27/2018] [Accepted: 12/24/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Microembolic signals (MES) and insulin resistance (IR) is common in patients with acute ischemic stroke (AIS). Patients with active MES tend to be more seriously ill and prone to aggravating disease progression. IR is an important risk factor for stroke which has been found to be associated with the severity of stroke. This study aims to investigate the clinical correlation between intracranial MES and IR in AIS patients. METHODS A total of 119 patients with AIS were enrolled in this study. The IR index (HOMA-IR) was calculated according to the homeostasis model and divided into 4 levels, where IR was defined by HOMA-IR index in the top quartile (Q4). Transcranial Doppler Sonography was performed in all patients within 72 hours after the stroke onset to monitor arterial MES in the lesion side of the brain for 30 minutes. RESULTS It is found that the positive rate of MES increased with the increase of IR level. The positive rate of MES in IR group was 55.2% (16/29), and that in non-IR group was 32.2% (29/90). In addition, HOMA-IR in patients with MES- were significantly lower than those in patients with MES+ (1.6 [Interquartile range: 0.9-2.5] compared with 2.2 [Interquartile range: 1.3-4.1], P < .05).In multiple logistic regression analysis, we calculated the OR of MES as compared with the HOMA-IR. The result of OR value is 1.38 (95% confidence interval: 1.05-1.82, P = .02). CONCLUSIONS IR is positively related to MES in patients with AIS. Higher level of IR might contribute to plaque destabilization and the formation of MES, which finally leading to the occurrence of stroke.
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Affiliation(s)
- Xuyou Zhou
- Department of neurology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Dongmei Zhang
- Clinical medicine research center, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yong Zhou
- Department of neurology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Fang Wang
- Department of neurology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiangyang Zhu
- Department of neurology, the Second Affiliated Hospital of Nantong University, Nantong, China.
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Epidemiological Evidence of the Relationship Between Diabetes and Dementia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1128:13-25. [DOI: 10.1007/978-981-13-3540-2_2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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Garg PK, Biggs ML, Kaplan R, Kizer JR, Heckbert SR, Mukamal KJ. Fasting and post-glucose load measures of insulin resistance and risk of incident atrial fibrillation: The Cardiovascular Health Study. Nutr Metab Cardiovasc Dis 2018; 28:716-721. [PMID: 29615289 PMCID: PMC6151262 DOI: 10.1016/j.numecd.2018.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Existing literature in individuals without diabetes has not demonstrated a relationship between IR and incident AF; however, data are limited and only fasting glucose measures of IR were assessed. We evaluated the relationship of both fasting and post-glucose load IR measures with the development of atrial fibrillation in nondiabetic older adults. METHODS AND RESULTS Among Cardiovascular Health Study participants, a population-based cohort of 5888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), those without prevalent AF or diabetes and with IR measures at baseline were followed for the development of AF, identified by follow-up visit electrocardiograms, hospital discharge diagnosis coding, or Medicare claims data, through 2014. Fasting IR was determined by the homeostatic model of insulin resistance (HOMA-IR) and post-glucose load IR was determined by the Gutt index. Cox proportional hazards models were used to determine the association of IR with risk of AF. Analyses included 3601 participants (41% men) with a mean age of 73 years. Over a median follow-up of 12.3 years, 1443 (40%) developed AF. After multivariate adjustment, neither HOMA-IR nor the Gutt index was associated with risk of developing AF [hazard ratios (95% confidence intervals): 0.96 (0.90, 1.03) for 1-SD increase in HOMA-IR and 1.03 (0.97, 1.10) for 1-SD decrease in the Gutt index]. CONCLUSIONS We found no evidence of an association between either fasting or post-glucose load IR measures and incident AF.
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Affiliation(s)
- P K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - M L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - R Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J R Kizer
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - S R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - K J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Liu J, Rutten-Jacobs L, Liu M, Markus HS, Traylor M. Causal Impact of Type 2 Diabetes Mellitus on Cerebral Small Vessel Disease: A Mendelian Randomization Analysis. Stroke 2018; 49:1325-1331. [PMID: 29686024 PMCID: PMC5976219 DOI: 10.1161/strokeaha.117.020536] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between type 2 diabetes mellitus (T2D) and cerebral small vessel disease (CSVD) is unclear. We aimed to examine the causal effect of T2D, fasting glucose levels, and higher insulin resistance on CSVD using Mendelian randomization. METHODS Five CSVD phenotypes were studied; 2 were clinical outcomes associated with CSVD (lacunar stroke: n=2191/27 297 and intracerebral hemorrhage [ICH]: n=2254/8195 [deep and lobar ICH]), whereas 3 were radiological markers of CSVD (white matter hyperintensities: n=8429; fractional anisotropy [FA]: n=8357; and mean diffusivity: n=8357). We applied 2 complementary analyses to evaluate the association of T2D with CSVD. First, we used summarized data from genome-wide association study to calculate the effects of T2D-related variants on CSVD with inverse-variance weighted and weighted median approaches. Second, we performed a genetic risk score approach to test the effects of T2D-associated variants on white matter hyperintensities, FA, and mean diffusivity using individual-level data in UK Biobank. RESULTS T2D was associated with higher risk of lacunar stroke (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.28; P=0.007) and lower mean FA (OR, 0.78; 95% CI, 0.66-0.92; P=0.004) but not white matter hyperintensities volume (OR, 1.01; 95% CI, 0.97-1.04; P=0.626), higher mean diffusivity (OR, 1.04; 95% CI, 0.89-1.23; P=0.612), ICH (OR, 1.07; 95% CI, 0.95-1.20; P=0.269), lobar ICH (OR, 1.07; 95% CI, 0.89-1.28; P=0.466), or deep ICH (OR, 1.16; 95% CI, 0.99-1.36; P=0.074). Weighted median and penalized median weighted analysis showed similar effect estimates of T2D on lacunar stroke and FA, but with wider CIs, meaning they were not significant. The genetic score on individual-level data was significantly associated with FA (OR, 0.63; 95% CI, 0.45-0.89; P=0.008) after adjusting for potential confounders. CONCLUSIONS Our Mendelian randomization study provides evidence to suggest that T2D may be causally associated with CSVD, in particular with lacunar stroke and FA.
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Affiliation(s)
- Junfeng Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Loes Rutten-Jacobs
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (L.R.-J.)
| | - Ming Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
| | - Hugh S Markus
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Matthew Traylor
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
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Homeostasis model assessment of insulin resistance in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke. Biosci Rep 2018; 38:BSR20180330. [PMID: 29588341 PMCID: PMC5938425 DOI: 10.1042/bsr20180330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
Abstract
Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17–2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale (r = 0.408; P<0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75–5.08; P=0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70–4.89), P=0.006) and 429% (5.29 (3.05–9.80), P<0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79–0.88) by adding HOMA-IR to clinical examination variables (P=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke.
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Qiu HC, Liu HZ, Li X, Zeng X, Zhao JZ. Insulin resistance as estimated by homeostasis model assessment predicts incident post-stroke depression in Chinese subjects from ischemic stroke. J Affect Disord 2018; 231:1-7. [PMID: 29408157 DOI: 10.1016/j.jad.2018.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Previous studies suggested that insulin resistance (IR) may be a significant causal risk factor for cardiovascular events and depression independent of other risk factors. In this prospective, we assess the value of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) at admission to predict post-stroke depression (PSD) later developed at 3 months follow-up. METHODS This prospective, multicenter cohort study was conducted from January 2015 through December 2016 in China. Clinical information and HOMA-IR was assessed at admission. Neurological and neuropsychological evaluations were conducted at the 3-month follow-up. RESULTS In the study population, 56.6% were male and the median age was 59 years (interquartile range [IQR]: 51-69). One hundred and eighty-six patients (26.6%) showed depression at 3 months after admission and in 53 patients (28.5%) this depression was classified as severe. For each 1-unit increase of HOMA-IR, the unadjusted and adjusted risk of PSD increased by 63% (odds ratios [OR]: 1.63; 95% confidence interval [CI]:1.44-1.85; P < 0.001) and 27% (1.27; 1.13-1.39; P = 0.002). In a multivariate model using the fourth quartiles of HOMA-IR vs. quartiles 1 through 3 together with the clinical variables, the marker displayed prognostic information (PSD: OR for fourth quartile, 2.76 [95% CI, 1.66-3.73; P = 0.003]). CONCLUSIONS The data suggests that the HOMA-IR may be of potential clinical relevance in identifying stroke patients at risk of developing depression, independent of the well-established predictors.
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Affiliation(s)
- Han-Cheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Translation Medicine for Cerebrovascular Diseases, Beijing, China
| | - Hui-Zhen Liu
- Department of Emergency, China Rehabilitation Research Center, Beijing, China
| | - Xuemei Li
- The Department of Neurosurgery, Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Xianwei Zeng
- The Department of Neurosurgery, Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Ji-Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Translation Medicine for Cerebrovascular Diseases, Beijing, China.
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Abstract
Insulin resistance often refers to a pathological condition in which cells fail to respond to the normal actions of insulin. Increasing literature has noted a critical role of insulin resistance in the pathogenesis of ischemic stroke. Insulin resistance plays an important role in the pathogenesis of ischemic stroke via enhancing advanced changes of atherosclerosis. A variety of literature indicates that insulin resistance enhances platelet adhesion, activation and aggregation which are conducive to the occurrence of ischemic stroke. Insulin resistance also induces hemodynamic disturbances and contributes to the onset of ischemic stroke. In addition, insulin resistance may augment the role of the modifiable risk factors in ischemic stroke and induce the occurrence of ischemic stroke. Preclinical and clinical studies have supported that improving insulin resistance may be an effective measure to prevent or delay ischemic stroke.
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Affiliation(s)
- Xiao-Ling Deng
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, 442000, Hubei Province, People's Republic of China
| | - Zhou Liu
- Department of Neurology, The Affiliated Hospital of Guangdong Medical University, and Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, People's Republic of China
| | - Chuanling Wang
- Department of Pathology, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Zhiyou Cai
- Department of Neurology, Chongqing General Hospital, No. 312 Zhongshan First Road, Yuzhong District, Chongqing, 400013, People's Republic of China.
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The diabetic brain and cognition. J Neural Transm (Vienna) 2017; 124:1431-1454. [PMID: 28766040 DOI: 10.1007/s00702-017-1763-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/13/2017] [Indexed: 12/20/2022]
Abstract
The prevalence of both Alzheimer's disease (AD) and vascular dementia (VaD) is increasing with the aging of the population. Studies from the last several years have shown that people with diabetes have an increased risk for dementia and cognitive impairment. Therefore, the authors of this consensus review tried to elaborate on the role of diabetes, especially diabetes type 2 (T2DM) in both AD and VaD. Based on the clinical and experimental work of scientists from 18 countries participating in the International Congress on Vascular Disorders and on literature search using PUBMED, it can be concluded that T2DM is a risk factor for both, AD and VaD, based on a pathology of glucose utilization. This pathology is the consequence of a disturbance of insulin-related mechanisms leading to brain insulin resistance. Although the underlying pathological mechanisms for AD and VaD are different in many aspects, the contribution of T2DM and insulin resistant brain state (IRBS) to cerebrovascular disturbances in both disorders cannot be neglected. Therefore, early diagnosis of metabolic parameters including those relevant for T2DM is required. Moreover, it is possible that therapeutic options utilized today for diabetes treatment may also have an effect on the risk for dementia. T2DM/IRBS contribute to pathological processes in AD and VaD.
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Jing J, Pan Y, Zhao X, Zheng H, Jia Q, Mi D, Chen W, Li H, Liu L, Wang C, He Y, Wang D, Wang Y, Wang Y. Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke: The ACROSS-China Study (Abnormal Glucose Regulation in Patients With Acute Stroke Across China). Stroke 2017; 48:887-893. [PMID: 28235959 DOI: 10.1161/strokeaha.116.015613] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Jing Jing
- 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.)
| | - Yuesong Pan
- 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.)
| | - Xingquan Zhao
- 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.)
| | - Huaguang Zheng
- 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.)
| | - Qian Jia
- 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.)
| | - Donghua Mi
- 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.)
| | - Weiqi Chen
- 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.)
| | - Hao Li
- 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.)
| | - Liping Liu
- 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.)
| | - Chunxue Wang
- 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.)
| | - Yan He
- 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.)
| | - David Wang
- 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.)
| | - Yilong Wang
- 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.)
| | - Yongjun Wang
- 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.).
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26
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Pan Y, Jing J, Chen W, Zheng H, Jia Q, Mi D, Li H, Zhao X, Liu L, Wang C, Gaisano HY, He Y, Wang Y, Wang Y. Post-Glucose Load Measures of Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke. J Am Heart Assoc 2017; 6:JAHA.116.004990. [PMID: 28108466 PMCID: PMC5523645 DOI: 10.1161/jaha.116.004990] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Insulin 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 Results Data 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 ISI0,120, 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 ISI0,120 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. Conclusions In this large‐scale registry, post–glucose load measures of insulin resistance with the ISI(composite) and the ISI0,120 were associated with 12‐month poor outcomes of nondiabetic patients with ischemic stroke.
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Affiliation(s)
- Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | | | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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27
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Agarwal I, Glazer NL, Barasch E, Djousse L, Gottdiener JS, Ix JH, Kizer JR, Rimm EB, Siscovick DS, King GL, Mukamal KJ. Associations between metabolic dysregulation and circulating biomarkers of fibrosis: the Cardiovascular Health Study. Metabolism 2015; 64:1316-23. [PMID: 26282733 PMCID: PMC4939831 DOI: 10.1016/j.metabol.2015.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/11/2015] [Accepted: 07/16/2015] [Indexed: 01/05/2023]
Abstract
AIM Fibrosis is one postulated pathway by which diabetes produces cardiac and other systemic complications. Our aim was to determine which metabolic parameters are associated with circulating fibrosis-related biomarkers transforming growth factor-β (TGF-β) and procollagen type III N-terminal propeptide (PIIINP). METHODS We used linear regression to determine the cross-sectional associations of diverse metabolic parameters, including fasting glucose, fasting insulin, body mass index, fatty acid binding protein 4, and non-esterified fatty acids, with circulating levels of TGF-β (n = 1559) and PIIINP (n = 3024) among community-living older adults in the Cardiovascular Health Study. RESULTS Among the main metabolic parameters we examined, only fasting glucose was associated with TGF-β (P = 0.03). In contrast, multiple metabolic parameters were associated with PIIINP, including fasting insulin, body mass index, and non-esterified fatty acids (P<0.001, P<0.001, P=0.001, respectively). These associations remained statistically significant after mutual adjustment, except the association between BMI and PIIINP. CONCLUSIONS Isolated hyperglycemia is associated with higher serum concentrations of TGF-β, while a broader phenotype of insulin resistance is associated with higher serum PIIINP. Whether simultaneous pharmacologic targeting of these two metabolic phenotypes can synergistically reduce the risk of cardiac and other manifestations of fibrosis remains to be determined.
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Affiliation(s)
- Isha Agarwal
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | | | - Eddy Barasch
- Department of Research and Education, St. Francis Hospital, The Heart Center, Roslyn, NY, USA; SUNY at Stony Brook, Stony Brook, NY, USA
| | - Luc Djousse
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John S Gottdiener
- Department of Medicine, University of Maryland Medical School, Baltimore, MD, USA
| | - Joachim H Ix
- Department of Medicine, University of California San Diego, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David S Siscovick
- The New York Academy of Medicine, New York, NY, USA; Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA; Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - George L King
- Research Division, Joslin Diabetes Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ken J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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28
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El Assar M, Angulo J, Santos-Ruiz M, Moreno P, Novials A, Villanueva-Peñacarrillo ML, Rodríguez-Mañas L. Differential effect of amylin on endothelial-dependent vasodilation in mesenteric arteries from control and insulin resistant rats. PLoS One 2015; 10:e0120479. [PMID: 25807378 PMCID: PMC4373784 DOI: 10.1371/journal.pone.0120479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/22/2015] [Indexed: 02/05/2023] Open
Abstract
Insulin resistance (IR) is frequently associated with endothelial dysfunction and has been proposed to play a major role in cardiovascular disease (CVD). On the other hand, amylin has long been related to IR. However the role of amylin in the vascular dysfunction associated to IR is not well addressed. Therefore, the aim of the study was to assess the effect of acute treatment with amylin on endothelium-dependent vasodilation of isolated mesenteric arteries from control (CR) and insulin resistant (IRR) rats and to evaluate the possible mechanisms involved. Five week-old male Wistar rats received 20% D-fructose dissolved in drinking water for 8 weeks and were compared with age-matched CR. Plasmatic levels of glucose, insulin and amylin were measured. Mesenteric microvessels were dissected and mounted in wire myographs to evaluate endothelium-dependent vasodilation to acetylcholine. IRR displayed a significant increase in plasmatic levels of glucose, insulin and amylin and reduced endothelium-dependent relaxation when compared to CR. Acute treatment of mesenteric arteries with r-amylin (40 pM) deteriorated endothelium-dependent responses in CR. Amylin-induced reduction of endothelial responses was unaffected by the H2O2 scavenger, catalase, but was prevented by the extracellular superoxide scavenger, superoxide dismutase (SOD) or the NADPH oxidase inhibitor (VAS2870). By opposite, amylin failed to further inhibit the impaired relaxation in mesenteric arteries of IRR. SOD, or VAS2870, but not catalase, ameliorated the impairment of endothelium-dependent relaxation in IRR. At concentrations present in insulin resistance conditions, amylin impairs endothelium-dependent vasodilation in mircrovessels from rats with preserved vascular function and low levels of endogenous amylin. In IRR with established endothelial dysfunction and elevated levels of amylin, additional exposure to this peptide has no effect on endothelial vasodilation. Increased superoxide generation through NADPH oxidase activity may be a common link involved in the endothelial dysfunction associated to insulin resistance and to amylin exposure in CR.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Javier Angulo
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Madrid, Spain
| | - Marta Santos-Ruiz
- Servicio de Análisis Clínicos del Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Paola Moreno
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Anna Novials
- Diabetes and Obesity Research Laboratory, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - María Luisa Villanueva-Peñacarrillo
- Department of Metabolism, Nutrition & Hormones, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Madrid, Spain
- Servicio de Geriatría del Hospital Universitario de Getafe, Getafe, Madrid, Spain
- * E-mail:
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29
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El Assar M, Sánchez-Puelles JM, Royo I, López-Hernández E, Sánchez-Ferrer A, Aceña JL, Rodríguez-Mañas L, Angulo J. FM19G11 reverses endothelial dysfunction in rat and human arteries through stimulation of the PI3K/Akt/eNOS pathway, independently of mTOR/HIF-1α activation. Br J Pharmacol 2015; 172:1277-91. [PMID: 25363469 PMCID: PMC4337701 DOI: 10.1111/bph.12993] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE FM19G11 up-regulates mammalian target of rapamycin (mTOR)/hypoxia inducible factor-1α (HIF-1α) and PI3K/Akt pathways, which are involved in endothelial function. We evaluated the effects of FM19G11 on defective endothelial vasodilatation in arteries from rats and humans and investigated the mechanisms involved. EXPERIMENTAL APPROACH Effects of chronic in vivo administration of FM19G11 on aortic endothelial vasodilatation were evaluated together with ex vivo treatment in aortic and mesenteric arteries from control and insulin-resistant rats (IRR). Its effects on vasodilator responses of penile arteries (HPRAs) and corpus cavernosum (HCC) from men with vasculogenic erectile dysfunction (ED) (model of human endothelial dysfunction) were also evaluated. Vascular expression of phosphorylated-endothelial NOS (p-eNOS), phosphorylated-Akt (p-Akt) and HIF-1α was determined by immunodetection and cGMP by elisa. KEY RESULTS Chronic administration of FM19G11 reversed the impaired endothelial vasodilatation in IRR. Ex vivo treatment with FM19G11 also significantly improved endothelium-dependent vasodilatation in aorta and mesenteric arteries from IRR. These effects were accompanied by the restoration of p-eNOS and cGMP levels in IRR aorta and were prevented by either NOS or PI3K inhibition. p-Akt and p-eNOS contents were increased by FM19G11 in aortic endothelium of IRR. FM19G11-induced restoration of endothelial vasodilatation was unaffected by mTOR/HIF-1α inhibitors. FM19G11 also restored endothelial vasodilatation in HPRA and HCC from ED patients. CONCLUSIONS AND IMPLICATIONS Stimulation of the PI3K/Akt/eNOS pathway by FM19G11 alleviates impaired NO-mediated endothelial vasodilatation in rat and human arteries independently of mTOR/HIF-1α activation. This pharmacological strategy could be beneficial for managing pathological conditions associated with endothelial dysfunction, such as ED.
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Affiliation(s)
- M El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de GetafeGetafe, Madrid, Spain
| | - J M Sánchez-Puelles
- Fundación para la Investigación Biomédica del Hospital Universitario de GetafeGetafe, Madrid, Spain
- Molecular Pharmacology Group, Cellular and Molecular Medicine Department, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | - I Royo
- Molecular Pharmacology Group, Cellular and Molecular Medicine Department, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | - E López-Hernández
- Molecular Pharmacology Group, Cellular and Molecular Medicine Department, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | - A Sánchez-Ferrer
- Fundación para la Investigación Biomédica del Hospital Universitario de GetafeGetafe, Madrid, Spain
| | - J L Aceña
- Departamento de Química Orgánica Facultad de Química, Universidad del País Vasco UPV/EHUSan Sebastián, Spain
| | - L Rodríguez-Mañas
- Fundación para la Investigación Biomédica del Hospital Universitario de GetafeGetafe, Madrid, Spain
- Servicio de Geriatría, Hospital Universitario de GetafeGetafe, Madrid, Spain
| | - J Angulo
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y CajalMadrid, Spain
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30
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Brundel M, Kappelle LJ, Biessels GJ. Brain imaging in type 2 diabetes. Eur Neuropsychopharmacol 2014; 24:1967-81. [PMID: 24726582 DOI: 10.1016/j.euroneuro.2014.01.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/23/2014] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with cognitive dysfunction and dementia. Brain imaging may provide important clues about underlying processes. This review focuses on the relationship between T2DM and brain abnormalities assessed with different imaging techniques: both structural and functional magnetic resonance imaging (MRI), including diffusion tensor imaging and magnetic resonance spectroscopy, as well as positron emission tomography and single-photon emission computed tomography. Compared to people without diabetes, people with T2DM show slightly more global brain atrophy, which increases gradually over time compared with normal aging. Moreover, vascular lesions are seen more often, particularly lacunar infarcts. The association between T2DM and white matter hyperintensities and microbleeds is less clear. T2DM has been related to diminished cerebral blood flow and cerebrovascular reactivity, particularly in more advanced disease. Diffusion tensor imaging is a promising technique with respect to subtle white matter involvement. Thus, brain imaging studies show that T2DM is associated with both degenerative and vascular brain damage, which develops slowly over the course of many years. The challenge for future studies will be to further unravel the etiology of brain damage in T2DM, and to identify subgroups of patients that will develop distinct progressive brain damage and cognitive decline.
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Affiliation(s)
- Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Howard G, Wagenknecht LE, Kernan WN, Cushman M, Thacker EL, Judd SE, Howard VJ, Kissela BM. Racial differences in the association of insulin resistance with stroke risk: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Stroke 2014; 45:2257-62. [PMID: 24968932 DOI: 10.1161/strokeaha.114.005306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Insulin resistance is associated with increased stroke risk, but the effect has not been adequately examined separately in white and black populations. METHODS The association of baseline insulin resistance with risk of cerebral infarction (CI) and intracerebral hemorrhage (ICH) was assessed in 12 366 white and 6782 black participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, recruited between 2003 and 2007 and followed for an average of 5.7 years. Insulin resistance was measured with the homeostasis model assessment-insulin resistance. RESULTS There were 364 incident CI and 41 incident ICH events. The risk for CI increased with the log of insulin resistance in whites (hazards ratio [HR]ln(IR)=1.17; 95% confidence interval [CI], 1.00-1.38) but was largely attenuated by adjustment for stroke risk factors (HRln(IR)=1.05; 95% CI, 0.88-1.26). There was no association in blacks (HRln(IR)=1.01; 95% CI, 0.81-1.25). After adjustment for demographic factors and risk factors, there was a significant difference by race in the association of insulin resistance with risk of ICH (P=0.07), with a decrease in the risk of ICH in whites (HRln(IR)=0.61; 95% CI, 0.35-1.04) but a nonsignificant increase in blacks (HRln(IR)=1.20; 95% CI, 0.60-2.39). CONCLUSIONS These data support the growing evidence that insulin resistance may play a more important role in stroke risk among white than black individuals and suggest a potentially discordant relationship of insulin resistance on CI and ICH among whites.
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Affiliation(s)
- George Howard
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.).
| | - Lynne E Wagenknecht
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Walter N Kernan
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Mary Cushman
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Evan L Thacker
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Suzanne E Judd
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Virginia J Howard
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
| | - Brett M Kissela
- From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.)
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Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SCC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-236. [PMID: 24788967 DOI: 10.1161/str.0000000000000024] [Citation(s) in RCA: 2819] [Impact Index Per Article: 281.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
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Abstract
Growing epidemiologic evidence has suggested that people with diabetes mellitus are at an increased risk for the development of dementia. However, the results for the subtypes of dementia are inconsistent. This review examines the risk of dementia in people with diabetes mellitus, and discusses the possible mechanism underpinning this association. Diabetes mellitus is associated with a 1.5- to 2.5-fold greater risk of dementia among community-dwelling elderly people. Notably, diabetes mellitus is a significant risk factor for not only vascular dementia, but also Alzheimer's disease. The mechanisms underpinning the association are unclear, but it may be multifactorial in nature, involving factors such as cardiovascular risk factors, glucose toxicity, changes in insulin metabolism and inflammation. The optimal management of these risk factors in early life may be important to prevent late-life dementia. Furthermore, novel therapeutic strategies will be needed to prevent or reduce the development of dementia in people with diabetes mellitus.
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Affiliation(s)
- Toshiharu Ninomiya
- The George Institute for Global Health, Sydney University, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia,
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Xun P, Wu Y, He Q, He K. Fasting insulin concentrations and incidence of hypertension, stroke, and coronary heart disease: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2013; 98:1543-54. [PMID: 24132974 PMCID: PMC3831539 DOI: 10.3945/ajcn.113.065565] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insulin resistance is a precursor of numerous chronic diseases, including cardiovascular disease (CVD). The fasting insulin concentration is considered a reasonable surrogate of insulin resistance, especially among nondiabetic individuals. OBJECTIVE We aimed to quantitatively summarize the literature on the association of fasting insulin concentrations with risk of hypertension, stroke, and coronary heart disease (CHD) by conducting a meta-analysis of prospective cohort studies. DESIGN Eligible studies were identified by searching PubMed and EMBASE through January 2013. Additional information was retrieved through Google Scholar or a hand review of the reference lists from relevant articles. Prospective cohort studies that reported RRs and corresponding 95% CIs for the association of interest were identified. Data were extracted independently by 2 investigators, and the weighted RRs and 95% CIs for the associations were obtained by using a random-effects model. RESULTS Of the 22 identified studies, 10 reported results on hypertension (36,617 individuals and 4491 cases), 7 on stroke (27,887 individuals and 1550 cases), and 9 on CHD (22,379 individuals and 1986 cases). Comparison of the highest with the lowest quantile of fasting insulin concentrations showed a pooled RR (95% CI) of 1.63 (1.35, 1.97) for hypertension, 1.18 (0.87, 1.60) for stroke, and 1.50 (1.28, 1.77) for CHD. Each 50-pmol/L increment in fasting insulin was associated with a 25% increase in risk of hypertension [RR: 1.25 (1.14, 1.36)] and a 16% increase in risk of CHD [RR: 1.16 (1.10, 1.22)] but was not associated with risk of stroke [RR: 0.999 (0.99, 1.01)]. CONCLUSIONS A higher fasting insulin concentration or hyperinsulinemia was significantly associated with an increased risk of hypertension and CHD but not stroke. This meta-analysis suggests that early fasting insulin ascertainment in the general population may help clinicians identify those who are potentially at high risk of CVD.
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Affiliation(s)
- Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN (PX and KH); the Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (YW); and the Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (QH)
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Ramos-Rodriguez JJ, Ortiz O, Jimenez-Palomares M, Kay KR, Berrocoso E, Murillo-Carretero MI, Perdomo G, Spires-Jones T, Cozar-Castellano I, Lechuga-Sancho AM, Garcia-Alloza M. Differential central pathology and cognitive impairment in pre-diabetic and diabetic mice. Psychoneuroendocrinology 2013; 38:2462-75. [PMID: 23790682 DOI: 10.1016/j.psyneuen.2013.05.010] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 04/11/2013] [Accepted: 05/13/2013] [Indexed: 12/12/2022]
Abstract
Although age remains the main risk factor to suffer Alzheimer's disease (AD) and vascular dementia (VD), type 2 diabetes (T2D) has turned up as a relevant risk factor for dementia. However, the ultimate underlying mechanisms for this association remain unclear. In the present study we analyzed central nervous system (CNS) morphological and functional consequences of long-term insulin resistance and T2D in db/db mice (leptin receptor KO mice). We also included C57Bl6 mice fed with high fat diet (HFD) and a third group of C57Bl6 streptozotocin (STZ) treated mice. Db/db mice exhibited pathological characteristics that mimic both AD and VD, including age dependent cognitive deterioration, brain atrophy, increased spontaneous hemorrhages and tau phosphorylation, affecting the cortex preferentially. A similar profile was observed in STZ-induced diabetic mice. Moreover metabolic parameters, such as body weight, glucose and insulin levels are good predictors of many of these alterations in db/db mice. In addition, in HFD-induced hyperinsulinemia in C57Bl6 mice, we only observed mild CNS alterations, suggesting that central nervous system dysfunction is associated with well established T2D. Altogether our results suggest that T2D may promote many of the pathological and behavioral alterations observed in dementia, supporting that interventions devoted to control glucose homeostasis could improve dementia progress and prognosis.
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Roshanravan B, Robinson-Cohen C, Patel KV, Ayers E, Littman AJ, de Boer IH, Ikizler TA, Himmelfarb J, Katzel LI, Kestenbaum B, Seliger S. Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol 2013; 24:822-30. [PMID: 23599380 DOI: 10.1681/asn.2012070702] [Citation(s) in RCA: 277] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinic-based cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m(2). Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality.
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Affiliation(s)
- Baback Roshanravan
- Division of Nephrology, Department of Medicine, University of Washington Kidney Research Institute, Box 359606, 325 9th Avenue, Seattle, WA 98104, USA.
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Wieberdink RG, Koudstaal PJ, Hofman A, Witteman JCM, Breteler MMB, Ikram MA. Insulin resistance and the risk of stroke and stroke subtypes in the nondiabetic elderly. Am J Epidemiol 2012; 176:699-707. [PMID: 23035021 DOI: 10.1093/aje/kws149] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Insulin resistance, which plays a key role in the development of diabetes mellitus, is a putative modifiable risk factor for stroke. The aim of this study was to investigate if markers of insulin resistance were associated with risk of stroke in the general elderly population. This study was part of the large population-based Rotterdam Study and included 5,234 participants who were aged 55 years or older and stroke free and diabetes free at baseline (1997-2001). Fasting insulin levels and homeostasis model assessment for insulin resistance were used as markers for insulin resistance. Cox regression was used to determine associations between insulin resistance markers and stroke risk, adjusted for age, sex, and potential confounders. During 42,806 person-years of follow-up (median: 8.6 years), 366 first-ever strokes occurred, of which 225 were cerebral infarctions, 42 were intracerebral hemorrhages, and 99 were unspecified strokes. Fasting insulin levels were not associated with risk of any stroke, cerebral infarction, or intracerebral hemorrhage. Homeostasis model assessment for insulin resistance, which almost perfectly correlated with fasting insulin levels, was also not associated with risk of stroke or stroke subtypes. In conclusion, in this population-based cohort study among nondiabetic elderly, insulin resistance markers were not associated with risk of stroke or any of its subtypes.
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Affiliation(s)
- Renske G Wieberdink
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Phipps MS, Jastreboff AM, Furie K, Kernan WN. The diagnosis and management of cerebrovascular disease in diabetes. Curr Diab Rep 2012; 12:314-23. [PMID: 22492061 DOI: 10.1007/s11892-012-0271-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cerebrovascular disease is a leading cause of morbidity and mortality in diabetes. Compared with nondiabetic patients, diabetic patients have at least twice the risk for stroke, earlier onset of symptoms, and worse functional outcomes. Approximately 20 % of diabetic patients will die from stroke, making it one of the leading causes of death in this population. Effective strategies for primary and secondary prevention of stroke have been developed in research cohorts that included both diabetic and nondiabetic patients. Nevertheless, prevention in diabetes has some specific considerations. In this paper, we summarize evidence to guide the diagnosis and management of stroke in diabetic patients. We propose that diabetic stroke patients should have a robust risk assessment to target interventions, like other patients with cerebrovascular disease, but with special attention to glycemic control and lifestyle modification.
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Affiliation(s)
- Michael S Phipps
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06519, USA.
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Abstract
Diabetes and ischaemic stroke often arise together. People with diabetes have more than double the risk of ischaemic stroke after correction for other risk factors, relative to individuals without diabetes. Multifactorial treatment of risk factors for stroke-in particular, lifestyle factors, hypertension, and dyslipidaemia-will prevent a substantial number of these disabling strokes. Hyperglycaemia occurs in 30-40% of patients with acute ischaemic stroke, also in individuals without a known history of diabetes. Admission hyperglycaemia is associated with poor functional outcome, possibly through aggravation of ischaemic damage by disturbing recanalisation and increasing reperfusion injury. Uncertainty surrounds the question of whether glucose-lowering treatment for early stroke can improve clinical outcome. Achievement of normoglycaemia in the early stage of stroke can be difficult, and the possibility of hypoglycaemia remains a concern. Phase 3 studies of glucose-lowering therapy in acute ischaemic stroke are underway.
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Mercurio V, Carlomagno G, Fazio V, Fazio S. Insulin resistance: Is it time for primary prevention? World J Cardiol 2012; 4:1-7. [PMID: 22279598 PMCID: PMC3262393 DOI: 10.4330/wjc.v4.i1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/07/2011] [Accepted: 12/14/2011] [Indexed: 02/06/2023] Open
Abstract
Insulin resistance is a clinical condition characterized by a decrease in sensitivity and responsiveness to the metabolic actions of insulin, so that a given concentration of insulin produces a less-than-expected biological effect. As a result, higher levels of insulin are needed to maintain normal glucose tolerance. Hyperinsulinemia, indeed, is one of the principal characteristics of insulin resistance states. This feature is common in several pathologic conditions, such as type 2 diabetes, obesity, and dyslipidemia, and it is also a prominent component of hypertension, coronary heart disease, and atherosclerosis. The presence of endothelial dysfunction, related to insulin resistance, plays a key role in the development and progression of atherosclerosis in all of these disorders. Insulin resistance represents the earliest detectable abnormality in type 2 diabetes, and is one of the major underlying mechanisms of hypertension and cardiovascular diseases. Its early detection could be of great importance, in order to set a therapeutic attack and to counteract the higher risk of diabetes and cardiovascular diseases.
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Affiliation(s)
- Valentina Mercurio
- Valentina Mercurio, Guido Carlomagno, Valeria Fazio, Serafino Fazio, Department of Internal Medicine, Cardiovascular and Immunologic Sciences, Federico II University of Naples, 80131 Napoli, Italy
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Kernan WN, Inzucchi SE. Metabolic rehabilitation: science gathers to support a new intervention to prevent stroke. Stroke 2011; 42:3333-5. [PMID: 21998067 DOI: 10.1161/strokeaha.111.632489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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