Medicus, Vol. 31 No. 1 Moždani udar, 2022.
Review article
Insulin Resistance as a Risk Factor for Stroke
Kristian Dominik Rudež
Zrinka Šakić
Marin Deškin
Dario Rahelić
Abstract
Cerebrovascular incidents represent the second most frequent cause of mortality in Croatia and the world, and the incidence of stroke has staggeringly increased in the previous decades. As it is considered that the majority of strokes could be prevented, there are increasing efforts toward identifying and treating risk factors that contribute to stroke. Increasing evidence suggests that insulin resistance plays a role in the pathophysiology of ischemic stroke by promoting advanced changes of atherosclerosis, platelet adhesion, activation, and aggregation, and inducing hemodynamic disturbances that contribute to the onset of ischemic stroke. Hyperglycemia is a frequent finding in patients with acute stroke, and it is associated with a larger ischemic area, complications during thrombolysis or mechanical thrombectomy, and worse long-term outcomes. According to the current recommendations of the European Stroke Organisation, it is important to maintain strict glycemic control in patients with acute stroke, however, there is some controversy about such an approach. The discovery of insulin resistance as a risk factor for stroke and myocardial infarction raised the prospect that pioglitazone, a drug that improves insulin sensitivity, could benefit patients with cerebrovascular disease. It has been shown that pioglitazone reduces the risk of recurrent stroke and reduces the overall risk of cardiovascular disease, including myocardial infarction. Further research is directed toward evaluating the management of hyperglycemia during stroke and identifying patients who would benefit most from preventive measures.
Keywords
stroke; insulin resistance; diabetes; pioglitazone
Hrčak ID:
275921
URI
Publication date:
2.5.2022.
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