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Vascular Risk Factor Profiles Differ Between MRI Defined Subtypes of Younger Onset Lacunar Stroke

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Peer-reviewed

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Article

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Authors

Jacobs, LCA 
Markus, HS 

Abstract

Background and Purpose Differing associations of vascular risk factors with lacunar infarct have been reported, which is likely due to diagnostic differences and possible heterogeneity in the pathogenesis underlying lacunar infarction. In a large MRI-verified cohort of lacunar infarct patients, we investigated the risk factor profile of lacunar infarction and MRI-characteristics. Methods 1023 patients with lacunar infarction (mean age 56.7 (SD 8.5)), were recruited from 72 stroke centres throughout the UK 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 hypertensities (WMH) and location of the acute lacunar infarct. Results Hypertension (OR 2.21 (95% CI 1.85-2.64)), diabetes (OR 2.10 (95% CI 1.61-2.73)), hyperlipidaemia (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 to healthy controls. Patients with multiple lacunar infarcts were more likely to be male (OR 2.53 (95% CI 1.81-3.53)) and have hypertension (OR 1.54 (95% CI 1.12-2.04)) compared to 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)). Conclusions In this MRI-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/or confluent WMH. The association of hypertension, smoking and renal impairment with the presence of multiple lacunar infarcts and/or confluent WMH might reflect a diffuse small vessel arteriopathy.

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Keywords

Journal Title

Stroke

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Journal ISSN

Volume Title

48

Publisher

American Heart Association
Sponsorship
British Heart Foundation (FS/15/61/31626)
Dr Rutten-Jacobs was supported by a British Heart Foundation Immediate Research Fellowship (FS/15/61/31626). The UK young lacunar stroke DNA study was funded by a grant from the Wellcome Trust (WT072952) and the Stroke Association (TSA 2010/01). The sponsors of the study had no role in the study design, data collection, data analysis, interpretation, writing of the article, or the decision to submit the article for publication. H.S. Markus was supported by a National Institute for Health Research Senior Investigator award and is supported by the Cambridge University Trust National Institute for Health Research Biomedical Research Centre.