Stroke: targeting insulin resistance may improve clinical outcomes

  • Ago T & al.
  • Neurology
  • 30 Mar 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • In patients with acute ischaemic stroke, insulin resistance was associated with unfavourable clinical outcomes at 3 months without increasing the risk for early stroke recurrence or mortality.

Why this matters

  • Therapies targeting insulin resistance can improve functional outcomes following ischaemic stroke.

Study design

  •  Study evaluated 4655 patients aged 70.3 years with acute ischaemic stroke between April 2009 and March 2015.
  • Association of the homeostasis model assessment of insulin resistance (HOMA-IR) score with clinical outcomes at 3 months was evaluated.
  • HOMA-IR score quintiles: ≤0.84, 0.85-1.22, 1.23-1.73, 1.74-2.68, ≥2.68.
  • Funding: Japan Society for the Promotion of Science.

Key results

  • The HOMA-IR score was associated with neurologic improvement (ORhighest vs lowest quintile, 0.68; P<.001) and poor functional outcome (ORhighest vs lowest quintile, 2.02; P<.001).
  • HOMA-IR was not associated with early (≤3 months) stroke recurrence or death.
  • The associations were maintained in:
    • nondiabetic patients: neurological improvement (ORhighest vs lowest quintile, 0.71; P=.002); functional outcomes (ORhighest vs lowest quintile, 2.16; P<.001),
    • nonobese patients: neurological improvement (ORhighest vs lowest quintile, 0.71; P=.004); functional outcomes (ORhighest vs lowest quintile, 1.87; P<.001).

Limitations

  • Patients without HOMA-IR data were not included.
  • Results may not be generalisable to other populations.