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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 (HbA1c) 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. HbA1c, 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 HbA1c, 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.
GLOSSARY
- ARIC=
- Atherosclerosis Risk in Communities;
- CI=
- confidence interval;
- HbA1c=
- glycated hemoglobin;
- ILL=
- infarct-like lesion;
- LDL=
- low-density lipoprotein;
- PR=
- prevalence ratio
Footnotes
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Study funding: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).
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Editorial, page 82
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Supplemental data at www.neurology.org
- Received March 18, 2011.
- Accepted July 6, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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