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Background and Purpose : Insulin resistance and hyperinsulinemia may contribute to the development of atherosclerosis by a direct effect on the artery. Chronic hyperinsulinism has been recognized as a risk factor for coronary atherosclerosis. However, little is known about the role of hyperinsulinemia in ischemic stroke. We undertook this study to clarify whether high insulin level is a causative factor in the pathogenesis of ischemic stroke. Methods : Forty-eight consecutive ischemic stroke patients without diabetes mellitus and hypertension were divided into three groups, according to clinical presentations, brain imaging, transcranial doppler, and cerebral angiographies: large-artery atherosclerosis group (LAA, n=20), small-vessel occlusion group (SVO,n=16), and cardioembolism group (CE, n=12). Fasting blood sugar (FBS), fasting and 2-hour postprandial insulin, and lipid levels were analyzed. Data of each group were compared with those of age-matched control subjects (n=16). Results : No significant differences in age, sex, blood pressure, FBS, and smoking habit were noted among the three groups and the control. There was a significant difference in 2-hour postprandial insulin levels among LAA, SVO, CE and the control group(mean ±SEM : 66±10.6, 27±5.5, 30±4.4, 28±6.1μU/mL ,respectively; P<0.001, ANOVA). 2-hour postprandial insulin levels were significantly higher in LAA compared with other three groups (ANOVA, Post Hoc Multiple comparison : Student-Newman-Keuls test). Conclusions:These findings suggest that increased postprandial insulin levels may be a potential pathogenetic factor for the development of large artery atherosclerosis. Korean Journal of Stroke 1999;1(2): 162~168
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