title: Racial differences in the association of insulin resistance with stroke risk: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: OBJECTIVE
  Insulin resistance is associated with increased stroke risk, but the effect has not been adequately examined separately in white and black populations.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: 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.). ghoward@uab.edu.
authors: George
authors: G
authors: Howard
authors: 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.).
authors: Lynne E
authors: LE
authors: Wagenknecht
authors: 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.).
authors: Walter N
authors: WN
authors: Kernan
authors: 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.).
authors: Mary
authors: M
authors: Cushman
authors: 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.).
authors: Evan L
authors: EL
authors: Thacker
authors: 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.).
authors: Suzanne E
authors: SE
authors: Judd
authors: 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.).
authors: Virginia J
authors: VJ
authors: Howard
authors: 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.).
authors: Brett M
authors: BM
authors: Kissela
mesh_terms: D001741:Black or African American; D000368:Aged; D044383:Black People; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance / Q000208:ethnology*; D020300:Intracranial Hemorrhages / Q000208:ethnology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000208:ethnology / Q000209:etiology*; D044465:White People
keywords: hemorrhage; infarction; insulin resistance; stroke