Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study

Neurology. 2012 Jan 10;78(2):102-8. doi: 10.1212/WNL.0b013e31823efc42. Epub 2011 Dec 14.

Abstract

Objective: Lacunar infarctions are mainly due to 2 microvascular pathologies: lipohyalinosis and microatheroma. Little is known about risk factor differences for these subtypes. We hypothesized that diabetes and glycated hemoglobin (HbA(1)c) would be related preferentially to the lipohyalinotic subtype.

Methods: We performed a cross-section analysis of the brain MRI data from 1,827 participants in the Atherosclerosis Risk in Communities study. We divided subcortical lesions ≤ 20 mm in diameter into those ≤ 7 mm (of probable lipohyalinotic etiology) and 8-20 mm (probably due to microatheroma) and used Poisson regression to investigate associations with the number of each type of lesion. Unlike previous studies, we also fitted a model involving lesions <3 mm.

Results: Age (prevalence ratio [PR] 1.11 per year; 95% confidence interval [CI] 1.08-1.14), black ethnicity (vs white, PR 1.66; 95% CI 1.27-2.16), hypertension (PR 2.12; 95% CI 1.61-2.79), diabetes (PR 1.42; 95% CI 1.08-1.87), and ever-smoking (PR 1.34; 95% CI 1.04-1.74) were significantly associated with lesions ≤ 7 mm. Findings were similar for lesions <3 mm. HbA(1)c, substituted for diabetes, was also associated with smaller lesions. Significantly associated with 8-20 mm lesions were age (PR 1.14; 95% CI 1.09-1.20), hypertension (PR 1.79; 95% CI 1.14-2.83), ever-smoking (PR 2.66; 95% CI 1.63-4.34), and low-density lipoprotein (LDL) cholesterol (PR 1.27 per SD; 95% CI 1.06-1.52). When we analyzed only participants with lesions, history of smoking (PR 1.99; 95% CI 1.23-3.20) and LDL (PR 1.33 per SD; 95% CI 1.08-1.65) were associated with lesions 8-20 mm.

Conclusions: Smaller lacunes (even those <3 mm) were associated with diabetes and HbA(1)c, and larger lacunes associated with LDL cholesterol, differences which support long-held theories relating to their underlying pathology. The findings may contribute to broader understanding of cerebral microvascular disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Atherosclerosis / epidemiology*
  • Brain / pathology*
  • Cholesterol, HDL / blood
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology
  • Ethnic Groups / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypertension / epidemiology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Models, Statistical
  • Prevalence
  • Residence Characteristics / statistics & numerical data
  • Risk Factors
  • Stroke, Lacunar / classification*
  • Stroke, Lacunar / epidemiology*

Substances

  • Cholesterol, HDL
  • Glycated Hemoglobin A