Insulin Resistance Is a Risk Factor for Silent Lacunar Infarction.
This study aims to investigate the association between insulin resistance (IR) and silent lacunar infarction (SLI) in healthy adults.



We recruited 2326 healthy Korean adults who took health checkups, including a brain magnetic resonance imaging. SLI was defined as an infarction measuring 0.3 to 1.5 cm in diameter that was localized in the territory of perforating branches of cerebral arteries, as seen in the brain magnetic resonance imaging. The homeostasis model assessment-estimated insulin resistance index was used for IR estimation, and the cutoff value for its diagnosis for Koreans was 2.56.



The mean age of the study population was 56.2 years (range, 40-79 years), and 1279 subjects (55.0%) were male. The prevalence of SLI and IR was 8.1% and 18.1%, respectively. In multivariate logistic analysis, after adjusting for traditional SLI-associated risk factors, IR was positively associated with the prevalence of SLI (adjusted odds ratio, 1.69; 95% confidence interval, 1.16-2.46). The proportion of subjects with multiple SLI lesions (≥2) was also higher in the IR (+) group than that in the IR (-) group (4.3% versus 1.7%; P<0.001). In ordered logistic regression, IR was positively associated with an increase in SLI severity (adjusted odds ratio, 1.76; 95% confidence interval, 1.21-2.56).



IR is an independent risk factor of SLI presence and its severity in Koreans. Whether improvement of IR might prevent SLI occurrence needs to be addressed by clinical trials.
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Ji Eun
JE
Lee
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Dong Wook
DW
Shin
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Jae Moon
JM
Yun
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Sang Hyuck
SH
Kim
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
You-Seon
YS
Nam
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
BeLong
B
Cho
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Jae-Sung
JS
Lim
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.).
Han-Yeong
HY
Jeong
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.). kkolzzi0@gmail.com hmkwon@snu.ac.kr.
Hyung-Min
HM
Kwon
From the Department of Family Medicine (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.) and Health Promotion Center (J.E.L., D.W.S., J.M.Y., S.H.K., Y.-S.N., B.C., J.-H.P.), Seoul National University Hospital, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.-S.L.); Department of Neurology, Aerospace Medical Center, Cheongju, Republic of Korea (H.-Y.J.); and Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Republic of Korea (H.-M.K.). kkolzzi0@gmail.com hmkwon@snu.ac.kr.
Jin-Ho
JH
Park
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D059409:Stroke, Lacunar / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology
infarction; insulin resistance; magnetic resonance imaging; multivariate analysis; stroke