Stroke: targeting insulin resistance may improve clinical outcomes

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 (OR_{highest vs lowest quintile}, 0.68; P<.001) and poor functional outcome (OR_{highest 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 (OR_{highest vs lowest quintile}, 0.71; P=.002); functional outcomes (OR_{highest vs lowest quintile}, 2.16; P<.001),
  • nonobese patients: neurological improvement (OR_{highest vs lowest quintile}, 0.71; P=.004); functional outcomes (OR_{highest vs lowest quintile}, 1.87; P<.001).

Limitations

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