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

被引：103

作者：

Bezerra, D. C. ^{[1
,3
]}

Sharrett, A. R. ^{[1
]}

Matsushita, K. ^{[1
]}

Gottesman, R. F. ^{[4
]}

Shibata, D. ^{[5
]}

Mosley, T. H., Jr. ^{[6
]}

Coresh, J. ^{[1
,2
]}

Szklo, M. ^{[1
]}

Carvalho, M. S. ^{[3
]}

Selvin, E. ^{[1
,2
]}

机构：

[1] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[2] Johns Hopkins Bloomberg Sch Publ Hlth, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[3] Fundacao Oswaldo Cruz, Rio De Janeiro, Brazil

[4] Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA

[5] Univ Washington, Med Ctr, Dept Radiol, Seattle, WA 98195 USA

[6] Univ Mississippi, Med Ctr, Dept Geriatr Med, Jackson, MS USA

来源：

NEUROLOGY | 2012年 / 78卷 / 02期

关键词：

SMALL VESSEL DISEASE; CORONARY-HEART-DISEASE; SILENT BRAIN INFARCTS; STROKE; PREVALENCE; HEMORRHAGE; SEVERITY; LESIONS; SPACES;

D O I：

10.1212/WNL.0b013e31823efc42

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 1.142.83), 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. Neurology (R) 2012; 78: 102-108

引用

页码：102 / 108

页数：7

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