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Differing Risk Factor Profiles of Ischemic Stroke Subtypes: Evidence for a Distinct Lacunar Arteriopathy?

Jackson, Caroline A; Hutchison, Aidan; Dennis, Martin S; Wardlaw, Joanna M; Lindgren, Arne LU ; Norrving, Bo LU ; Anderson, Craig S; Hankey, Graeme J; Jamrozik, Konrad and Appelros, Peter, et al. (2010) In Stroke: a journal of cerebral circulation 41(4). p.624-629
Abstract
BACKGROUND AND PURPOSE: 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... (More)
BACKGROUND AND PURPOSE: 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. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
stroke subtypes, risk factors, lacunar, stroke
in
Stroke: a journal of cerebral circulation
volume
41
issue
4
pages
624 - 629
publisher
American Heart Association
external identifiers
  • wos:000276106100014
  • pmid:20150553
  • scopus:77950244849
ISSN
1524-4628
DOI
10.1161/STROKEAHA.109.558809
language
English
LU publication?
yes
id
f20d39c2-1542-4e2a-93c7-2efbf7ddb481 (old id 1552711)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20150553?dopt=Abstract
date added to LUP
2010-03-03 14:43:01
date last changed
2018-06-24 04:23:41
@article{f20d39c2-1542-4e2a-93c7-2efbf7ddb481,
  abstract     = {BACKGROUND AND PURPOSE: 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.},
  author       = {Jackson, Caroline A and Hutchison, Aidan and Dennis, Martin S and Wardlaw, Joanna M and Lindgren, Arne and Norrving, Bo and Anderson, Craig S and Hankey, Graeme J and Jamrozik, Konrad and Appelros, Peter and Sudlow, Cathie L M},
  issn         = {1524-4628},
  keyword      = {stroke subtypes,risk factors,lacunar,stroke},
  language     = {eng},
  number       = {4},
  pages        = {624--629},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Differing Risk Factor Profiles of Ischemic Stroke Subtypes: Evidence for a Distinct Lacunar Arteriopathy?},
  url          = {http://dx.doi.org/10.1161/STROKEAHA.109.558809},
  volume       = {41},
  year         = {2010},
}