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Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

  1. A R Folsom,
  2. M L Rasmussen,
  3. L E Chambless,
  4. G Howard,
  5. L S Cooper,
  6. M I Schmidt and
  7. G Heiss
  1. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA. folsom@epi.umn.edu
    Diabetes Care 1999 Jul; 22(7): 1077-1083. https://doi.org/10.2337/diacare.22.7.1077
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    Abstract

    OBJECTIVE: We tested the hypothesis that diabetes, body fat distribution, and (in nondiabetic subjects) fasting insulin levels are positively associated with ischemic stroke incidence in the general population. RESEARCH DESIGN AND METHODS: As part of the Atherosclerosis Risk in Communities (ARIC) Study, we measured diabetes by using fasting glucose criteria, waist and hip circumferences, and fasting insulin levels with a radioimmunoassay in > 12,000 adults aged 45-64 years who had no cardiovascular disease at baseline. We followed them for 6-8 years for ischemic stroke occurrence (n = 191). RESULTS: After adjustment for age, sex, race, ARIC community, smoking, and education level, the relative risk of ischemic stroke was 3.70 (95% CI 2.7-5.1) for diabetes, 1.74 (1.4-2.2) for a 0.11 increment of waist-to-hip ratio, and 1.19 (1.1-1.3) for a 50-pmol/l increment of fasting insulin among nondiabetic subjects. Ischemic stroke incidence was not statistically significantly associated with BMI (comparably adjusted relative risk = 1.15, 95% CI 0.97-1.36). With adjustment for other stroke risk factors (some of which may mediate the effects of diabetes, fat distribution, and hyperinsulinemia), the relative risks for diabetes, waist-to-hip ratio, and fasting insulin level were 2.22 (95% CI 1.5-3.2), 1.08 (0.8-1.4), and 1.14 (1.01-1.3), respectively. CONCLUSIONS: Diabetes is a strong risk factor for ischemic stroke. Aspects of insulin resistance, as reflected by elevated waist-to-hip ratios and elevated fasting insulin levels, may also contribute to a greater risk of ischemic stroke.

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    July 1999, 22(7)
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    Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.
    A R Folsom, M L Rasmussen, L E Chambless, G Howard, L S Cooper, M I Schmidt, G Heiss
    Diabetes Care Jul 1999, 22 (7) 1077-1083; DOI: 10.2337/diacare.22.7.1077

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    Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.
    A R Folsom, M L Rasmussen, L E Chambless, G Howard, L S Cooper, M I Schmidt, G Heiss
    Diabetes Care Jul 1999, 22 (7) 1077-1083; DOI: 10.2337/diacare.22.7.1077
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