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Lacunar strokes in patients with diabetes mellitus: risk factors, infarct
location, and prognosis: the secondary prevention of small subcortical strokes
study
#MMPMID25034716
Palacio S
; McClure LA
; Benavente OR
; Bazan C 3rd
; Pergola P
; Hart RG
Stroke
2014[Sep]; 45
(9
): 2689-94
PMID25034716
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BACKGROUND AND PURPOSE: Diabetes mellitus is an independent risk factor for
lacunar strokes. Few data are available regarding patient features, infarct
location, and recurrent vascular events for patients with diabetes mellitus with
lacunar stroke. METHODS: We compared features at study entry and prognosis during
3.6 years of follow-up of patients with diabetes mellitus versus patients without
diabetes mellitus with recent lacunar stroke participating in the Secondary
Prevention of Small Subcortical Strokes (SPS3) randomized trial. RESULTS: Among
the 3020 participants, the prevalence of diabetes mellitus was 37% with a mean
duration of 11 years. Diabetes mellitus was independently associated with
slightly younger age (63 versus 64 years; P<0.001), Hispanic ethnicity (36%
versus 28%; P<0.0001), ischemic heart disease (11% versus 6%; P=0.002), and
peripheral vascular disease (5% versus 2%; P<0.001). Patients with diabetes
mellitus more frequently had intracranial stenosis ?50% (P<0.001), infarcts
involving the brain stem or cerebellum (P<0.001), and more extensive white matter
abnormalities (P<0.001). Patients with diabetes mellitus were almost twice as
likely to have a recurrent stroke (hazard ratio [HR], 1.8; 95% confidence
interval [CI], 1.4-2.3), recurrent ischemic stroke (HR, 1.8; 95% CI, 1.4-2.4),
disabling/fatal stroke (HR, 1.8; 95% CI, 1.2-2.9), myocardial infarction (HR,
1.7; 95% CI, 1.0-2.8), and death (HR, 2.1 95% CI, 1.6-2.8) compared with patients
without diabetes mellitus. CONCLUSIONS: Patients with diabetes mellitus with
lacunar stroke have a distinctive clinical profile that includes double the
prevalence of systemic and intracranial atherosclerosis, preferential involvement
of the posterior circulation, and a poor prognosis for recurrent stroke and
death. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00059306.
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