Abstract
Background and Purpose: This study aimed to investigate the association between insulin resistance (IR) and the overall cerebral small vessel disease (CSVD) burden.Methods: We recruited elderly, nondiabetic, healthy subjects prospectively. The overall effect of CSVD on the brain was described by a validated CSVD score. The homeostasis model assessment–estimated insulin resistance index (HOMA-IR) was used for IR estimation, and HOMA-IR ≥2.80 was defined as IR. We evaluated the association between IR and the increasing severity of CSVD score by ordinal regression models adjusting for demographics and cardiovascular risk factors.Results: A total of 156 healthy participants were recruited. The mean age was older in the IR group than in the non-IR group (70.03 vs. 67.45, p = 0.04), and the prevalence of hypertension was significantly higher in the IR group than in the non-IR group (82.35% vs. 53.28%, p < 0.01). In ordinal regression analysis, IR was positively associated with increasing severity of the total CSVD score (adjusted odds ratio, 3.74; 95% confidence interval, 1.63–5.08; p < 0.01) after adjusting traditional risk factors. Furthermore, HOMA-IR levels showed a positive dose-dependent correlation with the total CSVD score (p < 0.01, p for trend <0.01).Conclusions: IR is independently associated with increasing severity of the overall CSVD burden, independent of other clinical risk factors in an elderly, nondiabetic, healthy population. Furthermore, HOMA-IR level is correlated with the CSVD burden in a dose-dependent manner.
Highlights
Cerebral small vessel disease (CSVD) is a syndrome including clinical, neuroimaging, and neuropathological manifestation, caused by various conditions involving perforating vessels (Wardlaw et al, 2013a,b)
Neuroimaging features are diverse, so that the total CSVD score was created to capture the overall effect of CSVD on the brain, which incorporates white matter hyperintensity (WMH), cerebral microbleeds (CMB), lacunes, and enlarged perivascular spaces (EPVS; Huijts et al, 2013; Staals et al, 2014)
Emerging data demonstrated a possible causal relationship between Insulin resistance (IR) and individual components of CSVD, but little is known about the associations between IR and overall CSVD burden as different neuroimaging components of CSVD shared a common mechanism; the objective of this study, is to investigate whether IR is associated with the overall CSVD burden, independent of other clinical risk factors in an elderly, nondiabetic, healthy population
Summary
Cerebral small vessel disease (CSVD) is a syndrome including clinical, neuroimaging, and neuropathological manifestation, caused by various conditions involving perforating vessels (Wardlaw et al, 2013a,b). Emerging data demonstrated a possible causal relationship between IR and individual components of CSVD (lacunar infarction; Dearborn et al, 2015; Lee et al, 2016), but little is known about the associations between IR and overall CSVD burden as different neuroimaging components of CSVD shared a common mechanism; the objective of this study, is to investigate whether IR is associated with the overall CSVD burden, independent of other clinical risk factors in an elderly, nondiabetic, healthy population. This study aimed to investigate the association between insulin resistance (IR) and the overall cerebral small vessel disease (CSVD) burden
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