From the Department of Biostatistics (G.H., S.E.J.) and Department of Epidemiology (V.J.H.), UAB School of Public Health; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (L.E.W.); Department of Medicine, Yale University School of Medicine, New Haven, CT (W.N.K.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); and Department of Neurology, School of Medicine, University of Cincinnati, OH (B.M.K.).
Stroke. 2014 Aug;45(8):2257-62. doi: 10.1161/STROKEAHA.114.005306. Epub 2014 Jun 26.
Insulin resistance is associated with increased stroke risk, but the effect has not been adequately examined separately in white and black populations.
The association of baseline insulin resistance with risk of cerebral infarction (CI) and intracerebral hemorrhage (ICH) was assessed in 12 366 white and 6782 black participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, recruited between 2003 and 2007 and followed for an average of 5.7 years. Insulin resistance was measured with the homeostasis model assessment-insulin resistance.
There were 364 incident CI and 41 incident ICH events. The risk for CI increased with the log of insulin resistance in whites (hazards ratio [HR]ln(IR)=1.17; 95% confidence interval [CI], 1.00-1.38) but was largely attenuated by adjustment for stroke risk factors (HRln(IR)=1.05; 95% CI, 0.88-1.26). There was no association in blacks (HRln(IR)=1.01; 95% CI, 0.81-1.25). After adjustment for demographic factors and risk factors, there was a significant difference by race in the association of insulin resistance with risk of ICH (P=0.07), with a decrease in the risk of ICH in whites (HRln(IR)=0.61; 95% CI, 0.35-1.04) but a nonsignificant increase in blacks (HRln(IR)=1.20; 95% CI, 0.60-2.39).
These data support the growing evidence that insulin resistance may play a more important role in stroke risk among white than black individuals and suggest a potentially discordant relationship of insulin resistance on CI and ICH among whites.
胰岛素抵抗与中风风险增加相关，但在白人和黑人人群中，其影响尚未得到充分研究。
在 2003 年至 2007 年间招募的、平均随访 5.7 年的 REasons for Geographic And Racial Differences in Stroke（REGARDS）队列的 12366 名白人参与者和 6782 名黑人参与者中，评估基线胰岛素抵抗与脑梗死（CI）和颅内出血（ICH）风险的关系。用稳态模型评估-胰岛素抵抗来测量胰岛素抵抗。
发生了 364 例 CI 事件和 41 例 ICH 事件。白人的 CI 风险随着胰岛素抵抗的对数增加而增加（危险比[HR]ln（IR）=1.17；95%置信区间[CI]，1.00-1.38），但通过调整中风危险因素后，这种相关性基本减弱（HRln（IR）=1.05；95% CI，0.88-1.26）。在黑人中没有相关性（HRln（IR）=1.01；95% CI，0.81-1.25）。在调整人口统计学因素和危险因素后，种族与胰岛素抵抗与 ICH 风险之间的关联存在显著差异（P=0.07），白人的 ICH 风险降低（HRln（IR）=0.61；95% CI，0.35-1.04），但黑人的 ICH 风险增加不显著（HRln（IR）=1.20；95% CI，0.60-2.39）。
这些数据支持越来越多的证据表明，胰岛素抵抗可能在白人中风风险中比黑人更重要，并且表明在白人中，胰岛素抵抗与 CI 和 ICH 的关系可能存在潜在的不一致。
