Insulin Resistance and Risk of Ischemic Stroke Among Nondiabetic Individuals From the Northern Manhattan Study

Abstract
Insulin resistance (IR) is a metabolic disorder characterized by diminished tissue sensitivity to insulin that originates from environmental factors, such as a sedentary lifestyle, central obesity, and genetic predisposition.1 Insulin resistance is a pivotal pathophysiologic contributor to the increased risk of cardiovascular disease.2-5 Whether IR predicts ischemic stroke (IS) is still a matter of debate.4,6-10 We have yet to clarify whether IR is a risk factor for incident IS in the general population after accounting for traditional vascular and metabolic risk factors. The gold standard for direct measurement of insulin sensitivity and secretion are the euglycemic hyperinsulinemic clamp methods, which are cumbersome and unsuitable for epidemiologic studies. The homeostasis model assessment (HOMA) is a widely used clinical and epidemiologic tool for indirect estimates of insulin sensitivity and insulin secretion.11,12