Insulin resistance and risk for stroke

Area of Science:

• Endocrinology
• Neurology
• Metabolic Syndrome

Background:

• Insulin resistance is a primary defect in type 2 diabetes mellitus.
• It is also prevalent in non-diabetic individuals, particularly the elderly, certain ethnic groups, and those with hypertension, obesity, or vascular disease.
• Impaired intracellular signaling in muscle tissue, leading to defective glycogen synthesis, is the main pathophysiologic defect.

Purpose of the Study:

• To review the definition, epidemiology, and treatment of insulin resistance.
• To examine the association between insulin resistance and stroke risk.
• To discuss the potential role of new drugs in stroke prevention.

Main Methods:

• Literature search of Medline (1977-2001) and review of bibliographies.
• Identification of pertinent English-language publications.
• Analysis of nine studies (four case-control, five prospective observational cohort) examining insulin resistance and stroke risk.

Main Results:

• Insulin resistance is common in type 2 diabetes, elderly individuals, specific ethnic groups, and those with hypertension, obesity, physical deconditioning, and vascular disease.
• Insulin resistance is linked to metabolic, hematologic, and cellular changes that promote atherosclerosis and coagulation.
• Six of nine methodologically sound studies indicate a significant association between insulin resistance and stroke risk.

Conclusions:

• Insulin resistance is a prevalent risk factor for stroke.
• Emerging pharmacologic therapies can effectively reduce insulin resistance.
• These therapies may play a crucial role in the primary and secondary prevention of stroke.