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Published on: December 7, 2013

Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study

D C Bezerra1, A R Sharrett, K Matsushita

  • 1danielcbezerra@gmail.com

Neurology
|December 16, 2011
PubMed

Insights

Diabetes and HbA1c are linked to smaller lacunar infarcts, while LDL cholesterol is associated with larger ones. These findings differentiate risk factors for cerebral microvascular disease subtypes.

Area of Science:

  • Neurology
  • Vascular Biology
  • Medical Imaging

Background:

  • Lacunar infarctions stem from lipohyalinosis and microatheroma.
  • Risk factor distinctions between these lacunar infarction subtypes are not well understood.

Purpose of the Study:

  • To investigate differing risk factors for lipohyalinotic versus microatheroma lacunar infarction subtypes.
  • To test the hypothesis that diabetes and HbA1c are preferentially associated with lipohyalinosis.

Main Methods:

  • Cross-sectional analysis of 1,827 participants' brain MRI data from the Atherosclerosis Risk in Communities study.
  • Categorization of subcortical lesions by size (≤7 mm for lipohyalinosis, 8-20 mm for microatheroma), including analysis of lesions <3 mm.
  • Poisson regression modeling to assess associations between lesion counts and risk factors.

Main Results:

  • Smaller lesions (≤7 mm and <3 mm) were associated with diabetes, HbA1c, older age, black ethnicity, hypertension, and smoking.
  • Larger lesions (8-20 mm) were associated with older age, hypertension, smoking, and LDL cholesterol.
  • Smoking history and LDL cholesterol remained significant for larger lesions in analyses restricted to participants with lesions.

Conclusions:

  • Distinct risk factor profiles for small (diabetes, HbA1c) and large (LDL cholesterol) lacunar infarcts support etiological theories.
  • Findings enhance understanding of cerebral microvascular disease mechanisms and risk stratification.
Abstract

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