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Hyperinsulinism and cerebral microangiopathy

P Zunker¹, A Schick, H C Buschmann

¹Department of Neurology, University of Münster, Germany.

|February 1, 1996

Summary

High insulin levels are linked to cerebral small-vessel disease, particularly lacunar strokes. This suggests insulin may play a role in the development of microvascular brain pathology.

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Area of Science:

Neurology
Endocrinology
Vascular Biology

Background:

High insulin levels are a known risk factor for atherosclerosis.
The microvascular endothelium is more sensitive to insulin's effects than large-vessel endothelium.
Elevated insulin can impair fibrinolysis by increasing plasminogen activator inhibitor-1.

Purpose of the Study:

To investigate the association between elevated serum insulin and C-peptide levels and cerebral small-vessel disease.
To differentiate the role of insulin in small-vessel versus large-vessel cerebrovascular pathology.

Main Methods:

194 patients with symptomatic cerebrovascular disease were categorized into lacunar stroke, subcortical arteriosclerotic encephalopathy, and large-vessel disease groups.
Control subjects without cerebrovascular disease were also included.

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Fasting blood glucose, insulin, and C-peptide levels were measured in all participants.

Main Results:

Insulin levels were significantly higher in patients with lacunar strokes and subcortical arteriosclerotic encephalopathy (small-vessel disease) compared to those with large-vessel disease and controls.
A significant difference in insulin concentrations was observed between the microangiopathy group (lacunes and subcortical arteriosclerotic encephalopathy) and the macroangiopathy and control groups.
While C-peptide and blood glucose levels showed trends, differences did not reach statistical significance.

Conclusions:

Elevated insulin levels may be a pathogenic factor in the development of cerebral small-vessel disease, especially in patients with lacunar strokes.
Further research is needed to determine if this is due to atherosclerotic changes in small penetrating arteries or hemorheological alterations.