TY - JOUR
T1 - Obesity, Insulin Resistance, and Incident Small Vessel Disease on Magnetic Resonance Imaging
T2 - Atherosclerosis Risk in Communities Study
AU - Dearborn, Jennifer L.
AU - Schneider, Andrea L.C.
AU - Sharrett, A. Richey
AU - Mosley, Thomas H.
AU - Bezerra, Daniel C.
AU - Knopman, David S.
AU - Selvin, Elizabeth
AU - Jack, Clifford R.
AU - Coker, Laura H.
AU - Alonso, Alvaro
AU - Wagenknecht, Lynne E.
AU - Windham, Beverly G.
AU - Gottesman, Rebecca F.
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background and Purpose-The term metabolic syndrome describes the clustering of risk factors found in many individuals with obesity. Because of their pathophysiology, we hypothesized that 2 features of metabolic syndrome, central obesity and insulin resistance (IR), would be associated with cerebrovascular changes on magnetic resonance imaging, and specifically with incident lacunar disease and not white matter hyperintensity (WMH) progression. Methods-Risk factors were defined at study baseline in 934 participants in the Atherosclerosis Risk in Communities (ARIC) study, who completed 2 brain magnetic resonance imagings ≈10 years apart. WMH progression and incident lacunes between the 2 magnetic resonance imagings were determined. An IR score for each participant was created using principal component analysis of 11 risk factors, including (among others): insulin, homeostatic model assessment-IR, body mass index, and waist circumference. Metabolic syndrome (presence/absence), using standard clinical definitions, and IR score at the first magnetic resonance imaging, were independent variables, evaluated in multivariate logistic regression to determine odds of WMH progression (Q5 versus Q1-Q4) and incident lacunes. Results-Metabolic syndrome (adjusted odds ratio, 1.98; 95% confidence interval, 1.28-3.05) and IR score (adjusted odds ratio per 1-SD increase, 1.33; 95% confidence interval, 1.05-1.68) were associated with incident lacunes but not with WMH progression. Insulin, homeostatic model assessment-IR, and body mass index were not associated with incident lacunes or WMH progression in separate models. Conclusions-The IR score and central obesity are associated with incident lacunar disease but not WMH progression in individuals. Central obesity and IR may be important risk factors to target to prevent lacunar disease.
AB - Background and Purpose-The term metabolic syndrome describes the clustering of risk factors found in many individuals with obesity. Because of their pathophysiology, we hypothesized that 2 features of metabolic syndrome, central obesity and insulin resistance (IR), would be associated with cerebrovascular changes on magnetic resonance imaging, and specifically with incident lacunar disease and not white matter hyperintensity (WMH) progression. Methods-Risk factors were defined at study baseline in 934 participants in the Atherosclerosis Risk in Communities (ARIC) study, who completed 2 brain magnetic resonance imagings ≈10 years apart. WMH progression and incident lacunes between the 2 magnetic resonance imagings were determined. An IR score for each participant was created using principal component analysis of 11 risk factors, including (among others): insulin, homeostatic model assessment-IR, body mass index, and waist circumference. Metabolic syndrome (presence/absence), using standard clinical definitions, and IR score at the first magnetic resonance imaging, were independent variables, evaluated in multivariate logistic regression to determine odds of WMH progression (Q5 versus Q1-Q4) and incident lacunes. Results-Metabolic syndrome (adjusted odds ratio, 1.98; 95% confidence interval, 1.28-3.05) and IR score (adjusted odds ratio per 1-SD increase, 1.33; 95% confidence interval, 1.05-1.68) were associated with incident lacunes but not with WMH progression. Insulin, homeostatic model assessment-IR, and body mass index were not associated with incident lacunes or WMH progression in separate models. Conclusions-The IR score and central obesity are associated with incident lacunar disease but not WMH progression in individuals. Central obesity and IR may be important risk factors to target to prevent lacunar disease.
KW - atherosclerosis
KW - body mass index
KW - obesity
KW - risk factors
KW - white matter
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U2 - 10.1161/STROKEAHA.115.010060
DO - 10.1161/STROKEAHA.115.010060
M3 - Article
C2 - 26451022
AN - SCOPUS:84945898587
SN - 0039-2499
VL - 46
SP - 3131
EP - 3136
JO - Stroke
JF - Stroke
IS - 11
ER -