Abstract 152: Vascular Risk Factor Profiles Differ Between Subtypes of MRI Defined Younger Onset Lacunar Stroke
Introduction: The pathogenesis of lacunar infarct is poorly understood. Two pathological and radiological subtypes have been suggested: isolated infarcts due to microatheroma and multiple smaller lacunar infarcts due to lipohyalinosis. The latter subtype has been associated with leukoaraiosis (LA) on MRI. Differing associations of vascular risk factors with lacunar infarct have been reported, which is likely due to heterogeneity in the classification of lacunar infarcts. Therefore we aimed to investigate the risk factor profile of lacunar infarction and subtypes in a MRI verified cohort of lacunar infarct patients.
Methods: 1029 Caucasian patients with lacunar infarction, aged <=70 years (mean age 56.7 (SD8.5), range 20-70), were recruited from 72 specialist stroke centres throughout the UK as part of the Young Lacunar Stroke DNA Resource. Risk factor profiles were compared with 1962 stroke-free population controls. Lacunar infarct was subdivided on MRI into isolated lacunar infarction without confluent LA (ILI) and multiple lacunar infarcts and/or confluent LA (MLI/LA). All MRI’s and clinical histories were reviewed centrally.
Results: Lacunar infarct was associated with hypertension (OR 2.26 (95% CI 1.89-2.70)), diabetes (OR 2.13 (95% CI 1.63-2.79)), hyperlipidaemia (OR 1.79 (95% CI 1.50-2.12)) and smoking (OR 1.73 (95% CI 1.46-2.05)). The association with hypertension was stronger in women than in men (OR 3.65 (95% CI 2.63-5.07 and 1.83 (95% CI 1.48-2.26) respectively). Compared to ILI, the MLI/LA variant was associated with age (OR 1.04 (95% CI 1.02-1.05)), hypertension (OR 2.16 (95% CI 1.60-2.91)), smoking OR 1.48 (95%CI 1.11-1.96)) and lower estimated glomerular filtration rate (per 10 ml/min, OR 0.94 (95% CI 0.90-0.98)).
Conclusion: In this younger onset lacunar stroke population we identified a distinct risk factor profile in patients compared to controls. This risk factor profile differed between lacunar infarct subtypes. The association of the MLI/IL subtype with more severe hypertension and renal impairment might reflect a diffuse small vessel arteriopathy.
Author Disclosures: L.C. Rutten-Jacobs: None. H.S. Markus: None.
- © 2015 by American Heart Association, Inc.