Abstract
The association of insulin with atherosclerosis has been a subject of research for more than 3 decades. Several studies have shown that hyperinsulinemia is associated with the risk of coronary heart diseas, but information on the association of hyperinsulinemia with the risk of ischemic stroke is limited. According to recent prospective epidemiological studies, such as the Kuopio study and the Helsinki policemen study, fasting insulin level appears to be a risk factor for ischemic stroke. Furthermore, cross-sectional studies have shown that hyperinsulinemia or insulin resistance is associted with ultrasonographically assessed atherosclerosis in carotid arteries. Concerning the stroke type, insulin resistance and compensatory hyperinsulinemia seems to be an important pathogenetic factor underlying the development of atherothrombotic cerebral infarction in Japanese. However, in another German study, elevated insulin levels represent a pathogenetic factor in the development of cerebral small vessel disease, predominantly in patients presenting with lacunes. These diffenence may indicates racial difference. In relation to the insulin level, significance of fibrinogen and leptin is noticed. On the treatment of the stroke patients with hyperinsulinemia, calorie restriction, weight loss and exercise training is important. Antihypertensive drugs with improving insulin sensitivity are indicated for hypertensive patients.
