Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy?
OBJECTIVE
Differences in risk factor profiles between lacunar and other ischemic stroke subtypes may provide evidence for a distinct lacunar arteriopathy, but existing studies have limitations. We overcame these by pooling individual data on 2875 patients with first-ever ischemic stroke from 5 collaborating prospective stroke registers that used similar, unbiased methods to define risk factors and classify stroke subtypes.


METHODS
We compared risk factors between lacunar and nonlacunar ischemic strokes, altering the comparison groups in sensitivity analyses, and incorporated these data into a meta-analysis of published studies.


RESULTS
Unadjusted and adjusted analyses gave similar results. We found a lower prevalence of cardioembolic source (adjusted odds ratio, 0.33; 95% CI, 0.24 to 0.46), ipsilateral carotid stenosis (odds ratio, 0.21; 95% CI, 0.14 to 0.30), and ischemic heart disease (odds ratio, 0.75; 95% CI, 0.58 to 0.97) in lacunar compared with nonlacunar patients but no difference for hypertension, diabetes, or any other risk factor studied. Results were robust to sensitivity analyses and largely confirmed in our meta-analysis.


CONCLUSIONS
Hypertension and diabetes appear equally common in lacunar and nonlacunar ischemic stroke, but lacunar stroke is less likely to be caused by embolism from the heart or proximal arteries, and the lower prevalence of ischemic heart disease in lacunar stroke provides additional support for a nonatherosclerotic arteriopathy causing many lacunar ischemic strokes. Our findings have implications for how clinicians classify ischemic stroke subtypes and highlight the need for additional research into the specific causes of and treatments for lacunar stroke.
Division of Clinical Neurosciences, University of Edinburgh, United Kingdom.
Caroline A
CA
Jackson
Aidan
A
Hutchison
Martin S
MS
Dennis
Joanna M
JM
Wardlaw
Arne
A
Lindgren
Bo
B
Norrving
Craig S
CS
Anderson
Graeme J
GJ
Hankey
Konrad
K
Jamrozik
Peter
P
Appelros
Cathie L M
CL
Sudlow
D000368:Aged; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology; D020520:Brain Infarction / Q000145:classification / Q000453:epidemiology / Q000473:pathology; D002545:Brain Ischemia / Q000145:classification / Q000453:epidemiology / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000453:epidemiology / Q000473:pathology