BACKGROUND AND PURPOSE: Differences in risk factor profiles between lacunar and other ischemic stroke subtypes may provide evidence for a distinct lacunar arteriopathy, but existing studies have limitations. We overcame these by pooling individual data on 2875 patients with first-ever ischemic stroke from 5 collaborating prospective stroke registers that used similar, unbiased methods to define risk factors and classify stroke subtypes. METHODS: We compared risk factors between lacunar and nonlacunar ischemic strokes, altering the comparison groups in sensitivity analyses, and incorporated these data into a meta-analysis of published studies. RESULTS: Unadjusted and adjusted analyses gave similar results. We found a lower prevalence of cardioembolic source (adjusted odds ratio, 0.33; 95% CI, 0.24 to 0.46), ipsilateral carotid stenosis (odds ratio, 0.21; 95% CI, 0.14 to 0.30), and ischemic heart disease (odds ratio, 0.75; 95% CI, 0.58 to 0.97) in lacunar compared with nonlacunar patients but no difference for hypertension, diabetes, or any other risk factor studied. Results were robust to sensitivity analyses and largely confirmed in our meta-analysis. CONCLUSIONS: Hypertension and diabetes appear equally common in lacunar and nonlacunar ischemic stroke, but lacunar stroke is less likely to be caused by embolism from the heart or proximal arteries, and the lower prevalence of ischemic heart disease in lacunar stroke provides additional support for a nonatherosclerotic arteriopathy causing many lacunar ischemic strokes. Our findings have implications for how clinicians classify ischemic stroke subtypes and highlight the need for additional research into the specific causes of and treatments for lacunar stroke.
BACKGROUND AND PURPOSE: Differences in risk factor profiles between lacunar and other ischemic stroke subtypes may provide evidence for a distinct lacunar arteriopathy, but existing studies have limitations. We overcame these by pooling individual data on 2875 patients with first-ever ischemic stroke from 5 collaborating prospective stroke registers that used similar, unbiased methods to define risk factors and classify stroke subtypes. METHODS: We compared risk factors between lacunar and nonlacunar ischemic strokes, altering the comparison groups in sensitivity analyses, and incorporated these data into a meta-analysis of published studies. RESULTS: Unadjusted and adjusted analyses gave similar results. We found a lower prevalence of cardioembolic source (adjusted odds ratio, 0.33; 95% CI, 0.24 to 0.46), ipsilateral carotid stenosis (odds ratio, 0.21; 95% CI, 0.14 to 0.30), and ischemic heart disease (odds ratio, 0.75; 95% CI, 0.58 to 0.97) in lacunar compared with nonlacunar patients but no difference for hypertension, diabetes, or any other risk factor studied. Results were robust to sensitivity analyses and largely confirmed in our meta-analysis. CONCLUSIONS:Hypertension and diabetes appear equally common in lacunar and nonlacunar ischemic stroke, but lacunar stroke is less likely to be caused by embolism from the heart or proximal arteries, and the lower prevalence of ischemic heart disease in lacunar stroke provides additional support for a nonatherosclerotic arteriopathy causing many lacunar ischemic strokes. Our findings have implications for how clinicians classify ischemic stroke subtypes and highlight the need for additional research into the specific causes of and treatments for lacunar stroke.
Authors: D C Bezerra; A R Sharrett; K Matsushita; R F Gottesman; D Shibata; T H Mosley; J Coresh; M Szklo; M S Carvalho; E Selvin Journal: Neurology Date: 2011-12-14 Impact factor: 9.910
Authors: Jacques E Rossouw; Karen C Johnson; Mary Pettinger; Mary Cushman; Per Morten Sandset; Lewis Kuller; Frits Rosendaal; Jan Rosing; Sylvia Wasserthal-Smoller; Lisa W Martin; Joann E Manson; Kamakshi Lakshminarayan; Jose G Merino; John Lynch Journal: Stroke Date: 2012-02-23 Impact factor: 7.914
Authors: Alessandra Del Bene; Stephen D J Makin; Fergus N Doubal; Domenico Inzitari; Joanna M Wardlaw Journal: Stroke Date: 2013-09-05 Impact factor: 7.914
Authors: Marcio Francisco Lehmann; Ana Paula Kallaur; Sayonara Rangel Oliveira; Daniela Frizon Alfieri; Franciele Delongui; Johnathan de Sousa Parreira; Maria Caroline Martins de Araújo; Carolina Rossato; Jéssica Tavares de Almeida; Larissa Moliterno Pelegrino; Erick Frank Bragato; Ana Lucia Cruz Fürstenberger Lehmann; Helena Kaminami Morimoto; Marcell Alysson Batisti Lozovoy; Andrea Name Colado Simão; Damácio Ramon Kaimen-Maciel; Edna Maria Vissoci Reiche Journal: Metab Brain Dis Date: 2015-09-11 Impact factor: 3.584