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Combined effect of chronic inflammation and insulin resistance on stroke: a cohort study and mediation analysis
Yu Gao1, Zhiping Duan2, Jing Li1
1Internal Medicine Department for Officials, The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Road, Kunming, 650032, Yunnan Province, China.
Insights
Chronic inflammation and insulin resistance (IR) independently increase stroke risk. Their combined effect significantly elevates the risk, with each condition also mediating the other
Area of Science:
- Public Health
- Cardiovascular Research
- Metabolic Syndrome
Background:
- Stroke represents a significant global health burden.
- Investigating the synergistic impact of chronic inflammation and insulin resistance (IR) on stroke incidence is crucial.
- This study utilized high-sensitivity C-reactive protein (hsCRP) and the metabolic score for insulin resistance (MetS-IR) as biomarkers.
Purpose of the Study:
- To examine the independent and combined effects of chronic inflammation and IR on the risk of new-onset stroke.
- To explore the mediating roles of chronic inflammation and IR in stroke development.
- To assess the utility of hsCRP and MetS-IR in identifying individuals at high risk for stroke.
Main Methods:
- Utilized data from 7,422 Chinese adults (≥40 years) without prior stroke from the 2011 China Health and Retirement Longitudinal Study cohort.
- Calculated MetS-IR using fasting glucose, triglyceride, BMI, and HDL cholesterol levels.
- Employed Cox proportional risk modeling and mediation analysis to assess stroke risk associated with hsCRP and MetS-IR levels over an 8.6-year follow-up.
Main Results:
- A total of 781 participants (10.5%) experienced a new stroke during the follow-up period.
- Elevated chronic inflammation (hsCRP > 1 mg/L) increased stroke risk by 64% (HR 1.64), and elevated IR (MetS-IR > 34.4) increased risk by 51% (HR 1.51).
- Participants with both high chronic inflammation and high IR had a 95% increased stroke risk (HR 1.95), with significant bidirectional mediation observed between inflammation and IR.
Conclusions:
- Chronic inflammation and IR exert both independent and interactive effects on stroke risk.
- These conditions demonstrate a mutual mediation in the development of stroke.
- hsCRP and MetS-IR offer a practical approach for assessing stroke risk in primary care and public health settings.
Background:
Stroke is a major public health challenge, and the combined effects of chronic inflammation and insulin resistance (IR) on stroke require further investigation. This study used high-sensitivity C-reactive protein (hsCRP) and the metabolic score for insulin resistance (MetS-IR) to assess chronic inflammation and IR, respectively, and explored their combined effects on stroke in middle-aged and older Chinese adults.
Methods:
Based on the China Health and Retirement Longitudinal Study cohort, 7,422 participants ≥ 40 years old without stroke at baseline in 2011 were enrolled and followed up to 2020. MetS-IR was calculated from (ln 2 × fasting plasma glucose + triglyceride × body mass index)/ln high-density lipoprotein cholesterol. Participants were divided into four groups based on hsCRP (cut point 1 mg/L) and MetS-IR (cut point 34.4). Cox proportional risk modeling and mediation analysis were used to explore the effect of different inflammation and IR states on stroke.
Results:
During an average follow-up period of 8.6 years, a total of 781 (10.5%) participants experienced a new stroke. Compared with participants with lower levels of both chronic inflammation and IR, the hazard ratio (HR) and 95% confidence interval (CI) for stroke in the higher chronic inflammation group was 1.64 (1.31-2.07), the HR and 95%CI for the higher IR group was 1.51 (1.19-1.90), and for the group with both higher levels of chronic inflammation and IR it was 1.95 (1.58-2.41). In addition, IR mediated 15.6% of the effect of chronic inflammation on stroke; chronic inflammation mediated 13.1% of the effect of IR on stroke.
Conclusions:
Chronic inflammation and IR have independent and superimposed effects on new-onset stroke risk and mediate each other. In primary care and public health services, the use of hsCRP and MetS-IR to assess the body's chronic inflammation and IR status and further assess its risk of a new stroke is a simple and effective new approach.
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