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Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study
Journal article   Open access   Peer reviewed

Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study

Santiago Palacio, Leslie A McClure, Oscar R Benavente, Carlos Bazan, 3rd, Pablo Pergola and Robert G Hart
Stroke (1970), v 45(9), pp 2689-2694
Sep 2014
DOI: https://doi.org/10.1161/STROKEAHA.114.005018
PMID: 25034716
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1161/strokeaha.114.005018View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open
url
https://doi.org/10.1161/STROKEAHA.114.005018View
Published, Version of Record (VoR) Open

Abstract

Aged Diabetes Complications - epidemiology Female Follow-Up Studies Humans Intracranial Arteriosclerosis - physiopathology Male Middle Aged Prevalence Prognosis Recurrence Risk Factors Secondary Prevention Stroke, Lacunar - epidemiology Time Factors Treatment Outcome
Diabetes mellitus is an independent risk factor for lacunar strokes. Few data are available regarding patient features, infarct location, and recurrent vascular events for patients with diabetes mellitus with lacunar stroke. We compared features at study entry and prognosis during 3.6 years of follow-up of patients with diabetes mellitus versus patients without diabetes mellitus with recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial. Among the 3020 participants, the prevalence of diabetes mellitus was 37% with a mean duration of 11 years. Diabetes mellitus was independently associated with slightly younger age (63 versus 64 years; P<0.001), Hispanic ethnicity (36% versus 28%; P<0.0001), ischemic heart disease (11% versus 6%; P=0.002), and peripheral vascular disease (5% versus 2%; P<0.001). Patients with diabetes mellitus more frequently had intracranial stenosis ≥50% (P<0.001), infarcts involving the brain stem or cerebellum (P<0.001), and more extensive white matter abnormalities (P<0.001). Patients with diabetes mellitus were almost twice as likely to have a recurrent stroke (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.4-2.3), recurrent ischemic stroke (HR, 1.8; 95% CI, 1.4-2.4), disabling/fatal stroke (HR, 1.8; 95% CI, 1.2-2.9), myocardial infarction (HR, 1.7; 95% CI, 1.0-2.8), and death (HR, 2.1 95% CI, 1.6-2.8) compared with patients without diabetes mellitus. Patients with diabetes mellitus with lacunar stroke have a distinctive clinical profile that includes double the prevalence of systemic and intracranial atherosclerosis, preferential involvement of the posterior circulation, and a poor prognosis for recurrent stroke and death. http://www.clinicaltrials.gov. Unique identifier: NCT00059306.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Peripheral Vascular Disease
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