Lack of association between insulin resistance as estimated by homeostasis model assessment and stroke risk: A systematic review and meta-analysis

Abstract

Epidemiologic studies have reported conflicting results on the association between insulin resistance and risk of stroke. This meta-analysis sought to evaluate the association between homeostasis model assessment-insulin resistance (HOMA-IR) and risk of stroke. Eligible studies were identified by searching PubMed and Emabse databases up to December 2018. Prospective observational studies investigating the association between HOMA-IR and incident stroke were included. Seven studies involving 36,343 participants were identified. The pooled risk ratio (RR) of stroke was 1.29 (95% confidence intervals [CI] 0.89-1.87) for the highest versus the lowest HOMA-IR category. Similarly, individuals with insulin resistance did not significantly increase the risk of ischemic stroke (RR 1.65; 95%CI 0.76-3.56). Likewise, insulin resistance was also not associated with higher risk of stroke in the general population (RR 1.38; 95%CI 0.88-2.18) and non-diabetic population subgroup (RR 1.76; 95%CI 0.71-4.35). This meta-analysis suggests lack of association between HOMA-IR and risk of stroke. However, interpretation of these findings should be with caution due to the small number of studies analyzed and significant heterogeneity across studies.

Keywords: HOMA-IR; Insulin resistance; Meta-analysis; Stroke.