Retinal vessel abnormalities are associated with elevated fasting insulin levels and cerebral atrophy in nondiabetic individuals.
OBJECTIVE
To determine the impact of insulin resistance short of diabetes on the arteriolar-to-venular ratio (AVR) and whether AVR is related to cerebral atrophy.


METHODS
Cross-sectional study.


METHODS
Forty-six nondiabetic subjects with normal glucose tolerance and varying degrees of insulin resistance ranging in age from 43 to 77 years.


METHODS
Insulin resistance was assessed by fasting insulin and the homeostasis model assessment. Arteriolar-to-venular ratio was determined using digital retinal photography with a nonmydriatic camera, and retinal data were analyzed using a reliable semiautomated method. Cerebral atrophy was derived by means of manual tracing and thresholding procedures on structural magnetic resonance images.


METHODS
Arteriolar-to-venular ratio and cerebral atrophy.


RESULTS
Hyperinsulinemia negatively impacted AVR. Furthermore, AVR was associated with cerebral atrophy. Both of these findings were independent of the effects of age and hypertension.


CONCLUSIONS
These novel findings indicate that insulin resistance short of diabetes and independent of age and hypertension has a negative impact on retinal vessel health. Moreover, impaired retinal vessel health related to brain atrophy also was independent of hypertension and white matter hyperintensities. Given the connections between retinal and cerebral vasculature, this may offer a partial explanation for the presence of cognitive and brain abnormalities among individuals with insulin resistance.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Tirsi
Aziz
A
Department of Psychiatry, New York University School of Medicine, New York, New York 10016, USA.
Bruehl
Hannah
H
Sweat
Victoria
V
Tsui
Wai
W
Reddy
Shantan
S
Javier
Elizabeth
E
Lee
Carol
C
Convit
Antonio
A
D000328:Adult; D000368:Aged; D001284:Atrophy; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D001921:Brain / Q000473:pathology*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology*; D006973:Hypertension / Q000503:physiopathology; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010781:Photography; D012171:Retinal Vessels / Q000473:pathology*
D001786:Blood Glucose; D007328:Insulin; D005340:Fibrinogen; D002097:C-Reactive Protein