Background and Purpose
Diabetes is an independent risk factor for lacunar strokes. Few data are available regarding patient features, infarct location, and recurrent vascular events for diabetic patients with lacunar stroke.
We compared features at study entry and prognosis during 3.6 years of follow-up of diabetic vs. non-diabetic patients with recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial.
Among the 3020 participants, the prevalence of diabetes was 37% with a mean duration of 11 years. Diabetes was independently associated with slightly younger age (63 years vs. 64 years, p<0·001), Hispanic ethnicity (36% vs. 28%, p<0·0001), ischemic heart disease (11% vs. 6%, p=0·002), and peripheral vascular disease (5% vs. 2%, p<0·001). Diabetic patients more frequently had intracranial stenosis ≥50% (p<0·001), infarcts involving the brainstem or cerebellum (p<0·001), and more extensive white matter abnormalities (p<0·001). Diabetic patients were almost twice as likely to have a recurrent stroke (HR 1·8; 95% 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 non-diabetics.
Diabetic patients 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.