Hyperinsulinemia and cardiovascular risk factors in stroke patients

Abstract

To determine the presence of hyperinsulinemia in the absence of diabetes mellitus, a case-control study was carried out at the Out-Patient Clinic, Department of Neurology, Sardjito General Hospital, Yogyakarta, Indonesia. Patients included in the study were those who survived from stroke at least 3 months. Controls were selected from non-stroke patients at the same clinic with matching for sex and age. During the study 51 stroke patients (39 M, 12 F, age 58.73 ± 10.37 years) and 51 controls (39 M, 12 F, age 58.67 ± 9.97 years) were included. There was no significant difference of BMI (body mass index), smoking, and lipids except HDL-cholesterol levels between patients and controls. A significant reduced HDL- cholesterol concentrations (46.69 ± 16.05 vs 53.67 ± 23.26 mg/dl, p < 0.05) and significant higher BP (blood pressure) both systolic (160.50 ± 24.86 vs 131.30 ± 11.78 mmHg, p < 0.05) and diastolic (101.30 ± 13.03 vs 79.90 ± 4.74 mmHg, p < 0.05) were found in patients as compared to controls. Although there was no significant difference of fasting insulin levels (9.28 ± 2.74 vs 8.38 ± 2.69 μU/ml, p > 0.05), however, a significant increase of post prandial insulin levels (94.89 ± 12.15 vs 55.21 ± 6.88 μU/ml, p < 0.05) were found in patients as compared to controls. Although there was no significant difference of fasting insulin level both in NGT (normal glucose tolerance) and IGT (impaired glucose tolerance) subgroups, p > 0.05, however, there was a significant increase of post-prandial insulin levels both in NGT (98.15 ± 14.97 vs 38.76 + 6.62 μU/ml, p < 0.05) and IGT (89.85 ± 20.98 vs 75.24 ±11.82 μU/ml, p < 0.05) subgroups in patients as compared to controls. There was significant increase of risk of stroke in patients with postprandial hyperinsulinemia (odds 2.89 95% CI 1.14 to 7.40, p < 0.05) and fasting and/or post-prandial hyperinsulinemia (2.22 95% Cl 1.03 to 5.32, p < 0.05) compared to controls. In conclusion, although there was no diabetes mellitus in stroke patients, postprandial hyperinsulinemia was found. The hyperinsulinemia may be due to insulin resistance and associated with hypertension and reduced HDL-cholesterol concentrations.