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[Association of hypertension and diabetes mellitus with microangiopathic cerebral infarct patterns]
H Mast1, H C Koennecke, A Hartmann
1Neurologische Klinik, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
Insights
Hypertension and diabetes mellitus are significant risk factors for multiple lacunar infarcts and cerebral small-vessel disease. These findings highlight the importance of managing these conditions to prevent stroke.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Context:
- Cerebral small-vessel disease (CSVD) is a common finding in stroke patients.
- Lacunar infarcts and leucoaraiosis are key imaging markers of CSVD.
- The association between hypertension and diabetes mellitus with specific CSVD patterns requires further elucidation.
Purpose:
- To investigate the association between hypertension and diabetes mellitus with cerebral small-vessel disease infarct patterns.
- To differentiate the impact of these conditions on specific CSVD manifestations like multiple lacunar infarcts and leucoaraiosis.
Summary:
- A prospective study compared 152 patients with CSVD (lacunes/leucoaraiosis) and 106 patients with pial artery infarcts.
- Multivariate analysis revealed hypertension (OR 2.0) and diabetes (OR 1.9) are significantly associated with multiple lacunar infarcts/leucoaraiosis.
- Atrial fibrillation/left cardiac thrombus showed a negative association (OR 0.5) with lacunes/leucoaraiosis.
Impact:
- Hypertension and diabetes mellitus are identified as strong, independent determinants of multiple lacunar infarcts and leucoaraiosis.
- This research underscores the critical role of controlling hypertension and diabetes in mitigating the risk of specific stroke subtypes.
- Findings contribute to a better understanding of the pathophysiology of CSVD and stroke risk stratification.
Objective:
To test the hypothesis of a positive association of hypertension and diabetes mellitus with cerebral small-vessel disease infarct patterns.
Methods:
Using a prospective stroke database, the 152 patients with computertomographic signs of small-vessel disease (lacunes and/or leucoaraiosis)--including as a subgroup of 85 cases with multiple lacunes and/or leucoaraiosis-were compared with 106 patients featuring pial artery infarcts. Statistical analyses of the rates of hypertension and diabetes included univariate tests (odds ratios) and a logistic regression model comprising the additional variables hypercholesterolemia, cigarette smoking, carotid stenosis, atrial fibrillation, and left cardiac thrombus.
Results:
Multivariate testing revealed a significant association of hypertension and diabetes with multiple lacunar infarcts and/or leucoaraiosis (hypertension: odds ratio 2.0; 95% confidence interval 1.04-3.7; diabetes: odds ratio 1.9; 95% confidence interval 1.01-3.8), whereas for the total group of patients with small-vessel disease lesions no such effect was found. Among the other tested variables, only atrial fibrillation/left cardiac thrombus showed a significant negative association (odds ratio 0.5; 95% confidence interval 0.2-0.9) with lacunes/leucoaraiosis.
Conclusion:
Independent of other risk factors and other possible causes of stroke, both hypertension and diabetes appear to be strong determinants of multiple lacunar infarcts and/or leucoaraiosis.