The association of insulin resistance assessed by HOMA-IR and imaging features of cSVD
| Outcomes | Quartiles of HOMA-IR | Event, n (%) | Model 1* | Model 2† | Model 3‡ | |||
| Adjusted OR/cOR§ (95% CI) | P value | Adjusted OR/cOR (95% CI) | P value | Adjusted OR/cOR (95% CI) | P value | |||
| WMH burden¶ | Q1 (≤1.1) | 110 (16.4) | ref | ref | ref | |||
| Q2 (1.1–1.6) | 97 (13.9) | 0.92 (0.67 to 1.25) | 0.59 | 0.90 (0.66 to 1.24) | 0.51 | 0.78 (0.56 to 1.09) | 0.14 | |
| Q3 (1.6–2.2) | 98 (14.4) | 0.97 (0.71 to 1.33) | 0.87 | 0.95 (0.69 to 1.31) | 0.85 | 0.80 (0.56 to 1.13) | 0.21 | |
| Q4 (≥2.2) | 123 (17.5) | 1.27 (0.94 to 1.72) | 0.12 | 1.23 (0.90 to 1.69) | 0.19 | 0.94 (0.64 to 1.36) | 0.72 | |
| Severe ARWMC** | Q1 (≤1.1) | 36 (5.4) | ref | ref | ref | |||
| Q2 (1.1–1.6) | 32 (4.6) | 1.00 (0.61 to 1.65) | 1.00 | 0.98 (0.58 to 1.63) | 0.93 | 0.84 (0.50 to 1.43) | 0.53 | |
| Q3 (1.6–2.2) | 39 (5.7) | 1.33 (0.82 to 2.17) | 0.25 | 1.33 (0.80 to 2.20) | 0.27 | 1.11 (0.64 to 1.90) | 0.72 | |
| Q4 (≥2.2) | 42 (6.0) | 1.42 (0.88 to 2.30) | 0.16 | 1.39 (0.84 to 2.31) | 0.20 | 1.05 (0.58 to 1.89) | 0.88 | |
| Lacune | Q1 (≤1.1) | 29 (4.3) | ref | ref | ref | |||
| Q2 (1.1–1.6) | 36 (5.2) | 1.52 (0.91 to 2.54) | 0.11 | 1.48 (0.87 to 2.52) | 0.15 | 1.26 (0.72 to 2.18) | 0.42 | |
| Q3 (1.6–2.2) | 35 (5.1) | 1.65 (0.98 to 2.78) | 0.06 | 1.66 (0.97 to 2.86) | 0.07 | 1.35 (0.75 to 2.41) | 0.32 | |
| Q4 (≥2.2) | 40 (5.7) | 1.90 (1.14 to 3.17) | 0.01 | 1.90 (1.11 to 3.25) | 0.02 | 1.34 (0.72 to 2.51) | 0.36 | |
| Moderate-to-severe PVS†† | Q1 (≤1.1) | 77 (11.5) | ref | ref | ref | |||
| Q2 (1.1–1.6) | 47 (6.8) | 0.67 (0.45 to 1.00) | 0.05 | 0.69 (0.45 to 1.03) | 0.07 | 0.62 (0.40 to 0.94) | 0.02 | |
| Q3 (1.6–2.2) | 65 (9.5) | 1.09 (0.75 to 1.59) | 0.66 | 1.16 (0.78 to 1.70) | 0.47 | 1.05 (0.69 to 1.59) | 0.83 | |
| Q4 (≥2.2) | 74 (10.5) | 1.26 (0.87 to 1.83) | 0.21 | 1.34 (0.91 to 1.98) | 0.14 | 1.15 (0.73 to 1.81) | 0.55 | |
| CMBs | Q1 (≤1.1) | 77 (11.5) | ref | ref | ref | |||
| Q2 (1.1–1.6) | 64 (9.2) | 0.88 (0.61 to 1.25) | 0.47 | 0.87 (0.61 to 1.26) | 0.46 | 0.89 (0.61 to 1.30) | 0.56 | |
| Q3 (1.6–2.2) | 53 (7.8) | 0.76 (0.52 to 1.10) | 0.15 | 0.74 (0.51 to 1.10) | 0.13 | 0.79 (0.52 to 1.20) | 0.26 | |
| Q4 (≥2.2) | 72 (10.3) | 1.05 (0.74 to 1.49) | 0.80 | 1.05 (0.73 to 1.51) | 0.80 | 1.14 (0.74 to 1.75) | 0.56 | |
Significant p values have been presentd in bold.
*Model 1: multivariable regression model which was adjusted for age and gender.
†Model 2: model 2 adjusted for model 1+medical history including coronary artery disease, atrial fibrillation, dyslipidemia and stroke, smoking, alcohol intake, and medications including lipid-lowering, antiplatelet, anticoagulants.
‡Model 3: model 3 adjusted for model 2+medical history of hypertension, medications of antihypertension, systolic blood pressure, diastolic blood pressure, and body mass index.
§Ordinal logistic regression model was performed for WMH burden, total ARWMC score, and BG-PVS burden, and reported as cOR with 95% CIs, whereas logistic regression model was performed for lacunes and CMBs, and reported as OR with 95% CIs.
¶WMH burden was defined as either confluent deep WMH (Fazekas score 2 or 3) or irregular periventricular WMH extending into the deep white matter (Fazekas score 3).
**Based on the total ARWMC scale score, patients were divided into three groups: no ARWMC (score 0), mild-to-moderate ARWMC (score 1–10), and severe ARWMC (score >10).
††Moderate-to-severe PVS was defined as the PVS in the BG with grade 2–4.
ARWMC, age-related white matter changes; BG, basal ganglia; CMBs, cerebral microbleeds; cOR, common OR; cSVD, cerebral small vessel disease; HOMA-IR, homeostatic model assessment for insulin resistance; PVS, perivascular spaces; ref, reference; WMH, white matter hyperintensities.