Lacunar Strokes in Patients With Diabetes Mellitus: Risk Factors, Infarct Location, and Prognosis

Palacio, Santiago; McClure, Leslie A.; Benavente, Oscar; Bazán, Carlos; Pèrgola, Pablo E.; Hart, Robert G.

doi:10.1161/strokeaha.114.005018

Cited by 88 publications

(64 citation statements)

References 15 publications

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“…Regarding cerebral SVD, an increased prevalence of lacunar infarcts has been described in subjects with type 2 diabetes compared with subjects without DM (23). Further, patients with diabetes and lacunar strokes show a poorer prognosis than their nondiabetic counterparts (9). In our study, the frequency of lacunes was lower than those in previous studies, because our patients had no history of cerebrovascular disease.…”

Section: Discussioncontrasting

confidence: 57%

“…Lacunar infarcts or lacunes are small noncortical infarcts caused by the occlusion of small penetrating branches of large cerebral arteries. Several studies (9) have shown that diabetes is an independent risk factor for lacunar strokes. Finally, in patients with diabetes, the presence and severity of retinopathy are associated with future CV events, including ischemic stroke (10,11).…”

mentioning

confidence: 99%

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Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

et al. 2016

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OBJECTIVEWe sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. RESEARCH DESIGN AND METHODSWe evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTSThe prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables). CONCLUSIONSPatients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) morbidity and mortality. The chronic deleterious effects of hyperglycemia are classically separated into microvascular and macrovascular complications. In addition to the classic target organs of microangiopathy, such as the retina or the kidneys, the brain has also been described more recently as a target organ for diabetic microvascular complications (1).Cerebral small vessel disease (SVD) is the term commonly used to describe a syndrome of clinical, cognitive, neuroimaging, and neuropathological findings that

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Section: Discussioncontrasting

confidence: 57%

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confidence: 99%

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

et al. 2016

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“…However, the severity and type of hypertension differed across studies. For example, 1 study recruited patients who had been diagnosed with hypertension for at least 1 year and did not further restrict based on severity (18). However, >70% of the participants were already controlled on medication at study initiation.…”

Section: Results: Part 1 Study Characteristicsmentioning

confidence: 99%

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin¹,

Allen²,

Griswold³

et al. 2018

Hypertension

156

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These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. ‡Former Task Force member; current member during the writing effort. Copies: This document is available on the websites of the American College of Cardiology (www.acc.org) and the American Heart Association (professional.heart.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statements" drop-down menu, then click "Publication Development."Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page. With Hypertension .................................................................................................................................. 7 Introduction: Part 1 ............................................................................................................................ 1 ................................................................................................................................. 1 ....................................................................................................................... 1 .................................................................................................................................... ........................................................................................................................ 2 ................................................................................................................................ 2 ................................................................................................................................... ............................................................................................................................. ...................................................................................................................... 33 References ........................................................................................................................................ AbstractObjective: To review the literature systematically and perform meta-analyses to ...

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“…[17][18][19][20] In particular, DM predicted stroke recurrence in the settings of lacunar stroke and large artery atherosclerosis. 19,20 Our data first show that DM could be a risk factor for recurrent vascular events in ESUS patients with any underlying embolic causes. On the contrary, we show that the CAM score, based on the degree of aortic arch calcification on chest radiograph, age, and multiple brain infarcts, is independently associated with recurrent vascular events in patients with ESUS.…”

Section: Discussionmentioning

confidence: 99%

Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source

Ueno

Yamashiro

Tanaka

et al. 2016

Stroke

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Background and Purpose-Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source. Methods-Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included. Recurrent vascular events, including ischemic stroke, cardiovascular and peripheral artery diseases, and vascular death, were retrospectively analyzed. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, embolic causes on transesophageal echocardiography, and the Calcification in the Aortic Arch, Age, Multiple Infarction score (CAM), based on the degree of aortic arch calcification on chest radiograph (0-3 points), age (≥70 years; 1 point), and multiple infarctions on magnetic resonance imaging (multiple infarcts in 1, 2, or ≥3 territories of large intracranial arteries, 1, 2, or 3 points) associated with recurrent vascular events. Results-A total of 177 patients (age, 64.1±14.2 years; 127 men) were enrolled. Thirty-one patients had recurrent vascular events (follow-up, 3.5±2.7 years; annualized rate, 5.0% per person-year). Among embolic causes on transesophageal echocardiography, incidence of recurrent vascular events was high in patients with large aortic arch plaques (7.5% per person-year). Diabetes mellitus (hazard ratio, 2.56; 95% confidence interval, 1.23-5.32; P=0.012) and CAM score grade (hazard ratio, 2.29; 95% confidence interval, 1.11-4.72; P=0.026) predicted recurrent vascular events. Conclusions-History of diabetes mellitus and the CAM score could be novel risk factors for recurrent vascular events in embolic stroke of undetermined source.

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Lacunar Strokes in Patients With Diabetes Mellitus: Risk Factors, Infarct Location, and Prognosis

Cited by 88 publications

References 15 publications

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source

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