title: Recurrent vascular events in lacunar stroke  patients with metabolic syndrome and/or  diabetes.
abstract: OBJECTIVE
  We used a prospective clinical trial to examine the risks conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent strokes in the Secondary Prevention of Small Subcortical Strokes (SPS3) study cohort.
  
  
  METHODS
  The SPS3 trial enrolled 3,020 patients with lacunar strokes. Participants were stratified into groups of METS only, DM only, both, or neither using American Heart Association/National Heart, Lung, and Blood Institute and World Health Organization guidelines. Annualized event rates of strokes, myocardial infarction (MI), and all-cause mortality were calculated, and hazard ratios (HRs) referencing the “neither” group were computed, controlling for significantly associated baseline characteristics.
  
  
  RESULTS
  Among 2,999 participants, 25% had METS only, 6% had DM only, 32% had both conditions, and 37%had neither. Over a median of 3.8 years of follow-up, there were 274 recurrent strokes (240 ischemic, 34 hemorrhagic) and 74 MIs; among the 240 ischemic strokes, 134 (56%) were lacunar. The rates of any recurrent stroke (HR 1.7, 95% confidence interval [CI] 1.3–2.3) or lacunar stroke (HR 2.4, 95% CI 1.5–3.7) were significantly higher for those with concurrent METS and DM compared with those who had neither. Risk of incident MI was higher in participants with DM (HR 2.8, 95% CI 1.1–7.0) or concurrent DM and METS (HR 2.6, 95% CI 1.4–4.9).
  
  
  CONCLUSIONS
  METS and DM were significant comorbid conditions in lacunar stroke patients and they were associated with stroke recurrence. In patients with lacunar infarcts, a vigilant approach to prevent development of DM in those with METS may be a potential strategy to reduce recurrent strokes.
authors: Shuhan
authors: S
authors: Zhu
authors: Leslie A
authors: LA
authors: McClure
authors: Helena
authors: H
authors: Lau
authors: Jose R
authors: JR
authors: Romero
authors: Carole L
authors: CL
authors: White
authors: Viken
authors: V
authors: Babikian
authors: Thanh
authors: T
authors: Nguyen
authors: Oscar R
authors: OR
authors: Benavente
authors: Carlos S
authors: CS
authors: Kase
authors: Aleksandra
authors: A
authors: Pikula
mesh_terms: D000368:Aged; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000150:complications* / Q000517:prevention & control*; D014481:United States