Vascular Risk Factor Profiles Differ Between Magnetic Resonance Imaging-Defined Subtypes of Younger-Onset Lacunar Stroke.

Loes C.A Rutten-Jacobs,Hugh S Markus

doi:10.1161/strokeaha.117.017813

Abstract

Differing associations of vascular risk factors with lacunar infarct have been reported, which is likely because of diagnostic differences and possible heterogeneity in the pathogenesis underlying lacunar infarction. In a large magnetic resonance imaging-verified cohort of lacunar infarct patients, we investigated the risk factor profile of lacunar infarction and magnetic resonance imaging characteristics. One thousand twenty-three patients with lacunar infarction (mean age, 56.7; SD, 8.5) were recruited from 72 stroke centers throughout the United Kingdom as part of the UK Young Lacunar Stroke DNA Study. Risk factor profiles were compared with 1961 stroke-free population controls with similar age. Furthermore, we tested risk factor profiles of lacunar stroke patients for association with the presence of multiple lacunar infarcts, white matter hyperintensities (WMH), and location of the acute lacunar infarct. Hypertension (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.85-2.64), diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), hyperlipidemia (OR, 1.74; 95% CI, 1.46-2.07), and smoking (OR, 1.65; 95% CI, 1.39-1.96) were independently associated in lacunar infarct patients compared with healthy controls. Patients with multiple lacunar infarcts were more likely to be men (OR, 2.53; 95% CI, 1.81-3.53) and have hypertension (OR, 1.54; 95% CI, 1.12-2.04) compared with patients with a single lacunar infarct, independent of other vascular risk factors. The presence of moderate-to-severe WMH versus no or mild WMH was independently associated with increased age (OR, 1.54; 95% CI, 1.12-2.04), hypertension (OR, 2.06; 95% CI, 1.44-2.95), and impaired renal function (OR, 0.90; 95% CI, 0.82-0.98). In this magnetic resonance imaging-verified lacunar stroke population, we identified a distinct risk factor profile in the group as a whole. However, there were differing risk factor profiles according to the presence of multiple lacunar infarcts and confluent WMH. The association of hypertension, smoking, and renal impairment with the presence of multiple lacunar infarcts and confluent WMH might reflect a diffuse small vessel arteriopathy.

Highlights

Background and PurposeDiffering associations of vascular risk factors with lacunar infarct have been reported, which is likely because of diagnostic differences and possible heterogeneity in the pathogenesis underlying lacunar infarction
Hypertension, diabetes mellitus (OR, 2.10; 95% confidence intervals (CIs), 1.61–2.73), hyperlipidemia (OR, 1.74; 95% CI, 1.46–2.07), and smoking (OR, 1.65; 95% CI, 1.39–1.96) were independently associated in lacunar infarct patients compared with healthy controls
The presence of moderate-to-severe white matter hyperintensities (WMH) versus no or mild WMH was independently associated with increased age (OR, 1.54; 95% CI, 1.12–2.04), hypertension (OR, 2.06; 95% CI, 1.44–2.95), and impaired renal function (OR, 0.90; 95% CI, 0.82–0.98)

Summary

Methods

One thousand twenty-three patients with lacunar infarction (mean age, 56.7; SD, 8.5) were recruited from 72 stroke centers throughout the United Kingdom as part of the UK Young Lacunar Stroke DNA Study. We tested risk factor profiles of lacunar stroke patients for association with the presence of multiple lacunar infarcts, white matter hyperintensities (WMH), and location of the acute lacunar infarct. A total of 1023 white patients with MRI-confirmed lacunar stroke, aged ≤70 years, were recruited from 72 specialist stroke centers throughout the United Kingdom, between 2002 and 2012, as part of the young lacunar stroke DNA resource (online-only Data Supplement). Lacunar stroke was defined as a clinical lacunar syndrome[15] with a compatible lesion on MRI (subcortical infarct ≤15 mm in diameter). All cases were screened for CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy) and Fabry disease mutations; positive cases were subsequently excluded.[17]

Results

Discussion

Conclusion