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Increased insulin resistance and risk of incident cerebrovascular events in patients with pre-existing atherothrombotic disease
European Journal of Neurology, 06/17/09

Tanne D et al. – Increased insulin resistance did not predict incident cerebrovascular events among pts with pre-existing atherothrombotic disease.

• Study of whether increased insulin resistance is associated with incident cerebrovascular events for pts with pre-existing atherothrombotic disease
• Pts with stable coronary heart disease in secondary prevention trial followed up for mean of 6.2 yrs
• Coronary heart disease documented by history of myocardial infarction ≥6 mo and <5 yrs pre-enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing
• Main exclusion criteria: insulin-treated diabetes, hepatic or renal failure, and disabling stroke
• Baseline insulin levels measured in 2938 pts from stored frozen plasma samples
• Increased insulin resistance assessed by homeostatic model assessment of insulin resistance (HOMA-IR), categorized into tertiles or quartiles

• Crude rates of incident cerebrovascular events rose from 5.0% for HOMA-IR at bottom tertile to 5.7% at middle tertile, and 7.0% at top tertile
• HOMA-IR at top vs bottom tertile associated with unadjusted hazard ratio (HR) of 1.37 and a 1-unit increase in HOMA-IR associated with HR of 1.14
• On analyses adjusting for potential confounders, or categorizing baseline HOMA-IR into quartiles, or excluding diabetic pts, no increased risk for incident cerebrovascular events conferred by top category

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