Insulin resistance based on postglucose load measure is associated with prevalence and burden of cerebral small vessel disease

INTRODUCTION: Cerebral small vessel disease (cSVD) is highly prevalent and results in irreversible cognitive impairment and reduced quality of life. Previous studies reported controversial associations between insulin resistance and cSVD. Here, we estimated the association between insulin resistance and cSVD in non-diabetic communities in southeastern China. RESEARCH DESIGN AND METHODS: The Polyvascular Evaluation for Cognitive Impairment and Vascular Events study (NCT03178448) recruited 3067 community-dwelling adults. We estimated the association of insulin resistance, assessed by the insulin sensitivity index (ISI(0,120)) and the homeostatic model assessment for insulin resistance (HOMA-IR) based on the standard oral glucose tolerance test, with cSVD in those without a history of diabetes mellitus. cSVD was measured for both main neuroimaging manifestations of cSVD and total SVD burden scores. RESULTS: A total of 2752 subjects were enrolled. In the multivariable logistic regression analysis, the first quartile of ISI(0,120) was found to be potentially associated with an increased risk of lacunes (OR 1.96, 95% CI 1.15 to 3.36), severe age-related white matter changes (OR 1.97, 95% CI 1.15 to 3.38), and higher total SVD burden (4-point scale: common OR (cOR) 1.34, 95% CI 1.04 to 1.72; 6-point scale: cOR 1.43, 95% CI 1.14 to 1.80). The associations between HOMA-IR and lacunes (OR 1.90, 95% CI 1.11 to 3.25) and the 4-point scale of total SVD burden (cOR 1.33, 95% CI 1.04 to 1.70) were also significant after adjustment for age, gender, medical history, and medications. However, the associations were not statistically significant after further adjustment for blood pressure/hypertension and body mass index (BMI). CONCLUSIONS: A potential association was found between insulin resistance and cSVD, and the ISI(0,120) index presented a greater association with increased risk of cSVD as compared with the HOMA-IR. However, these associations were greatly influenced by blood pressure and BMI.