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Hypertension and diabetes mellitus as determinants of multiple lacunar infarcts
H Mast1, J L Thompson, S H Lee
1Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032.
Insights
Multiple lacunar infarcts are strongly associated with hypertension and diabetes mellitus. Diastolic blood pressure is a key determinant, suggesting distinct causes for different lacunar stroke types.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Lacunar infarcts are small strokes often associated with hypertension and diabetes.
- Understanding the specific risk factors for different types of lacunar infarcts is crucial for effective stroke prevention.
Purpose of the Study:
- To investigate the relationship between hypertension, diabetes mellitus, and the presence of single versus multiple lacunar infarcts.
- To determine the influence of blood pressure (diastolic and systolic) on lacunar infarcts.
Main Methods:
- Analysis of 637 ischemic stroke cases from the Stroke Data Bank, categorizing infarcts as lacunar or nonlacunar.
- Subgroup analysis of lacunar infarcts into single (n=144) and multiple (n=40) cases.
- Logistic regression models were used to assess the association of hypertension, diabetes, cardiac disease, and blood pressure with lacunar infarcts, controlling for age and sex.
Main Results:
- Hypertension (OR 2.5) and diabetes (OR 2.3) were significantly associated with multiple lacunar infarcts, but not single ones.
- Diastolic blood pressure (OR 1.4) significantly predicted multiple lacunar infarcts, while systolic pressure did not.
- Cardiac disease showed an inverse association with both single and multiple lacunar infarcts.
Conclusions:
- Multiple lacunar infarcts appear to have a distinct etiology strongly linked to hypertension and diabetes.
- Single lacunar infarcts may be influenced by different stroke risk factors.
- Diastolic blood pressure is a more critical determinant of multiple lacunar infarcts than systolic pressure.
Background And Purpose:
We investigated the relationship between hypertension, diabetes mellitus, and lacunes.
Methods:
From 1237 cases of ischemic stroke in the Stroke Data Bank of the National Institute of Neurological and Communicative Disorders and Stroke, data from 637 patients whose initial computed tomogram showed lacunar (n = 184) or nonlacunar infarcts (n = 453) were analyzed. The group with lacunar infarcts was further divided into subgroups according to whether the patients had multiple (n = 40) or single (n = 144) lacunar infarcts. The association of hypertension and diabetes mellitus with lacunar infarcts was investigated using logistic regression models that included age, sex, and cardiac disease. Similar models were used to analyze the effects of diastolic and systolic blood pressure.
Results:
Hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1 to 6.0) and diabetes (OR, 2.3; 95% CI, 1.1 to 4.5) were significantly related to multiple but not to single lacunes. Cardiac disease was inversely associated with both single and multiple lacunes. Diastolic blood pressure significantly affected the probability of multiple lacunar infarcts (OR, 1.4; 95% CI, 1.04 to 1.9), whereas systolic pressure did not.
Conclusions:
There may be etiologically distinct lacunar infarct subgroups, with multiple lacunes being strongly related to hypertension and diabetes mellitus. Other stroke risk factors may be more important in patients with single lacunes. Diastolic rather than systolic pressure seems to be a major determinant of multiple lacunes.