ASSOCIATION OF HYPERTENSION AND DIABETES- MELLITUS WITH LACUNAR BRAININFARCTS AND LEUCOARAIOSIS

Objective: To test the hypothesis of a positive association of hyperte nsion and diabetes mellitus with cerebral small-vessel disease infarct patterns. Methods: Using a prospective stroke database, the 152 patie nts with computertomographic signs of small-vessel disease (lacunes an d/or leucoaraiosis) - including as a subgroup of 85 cases with multipl e lacunes and/or leucoaraiosis were compared with 106 patients featuri ng pial artery infarcts. Statistical analyses of the rates of hyperten sion and diabetes included univariate tests (odds ratios) and a logist ic regression model comprising the additional variables hypercholester olemia, cigarette smoking, carotid stenosis, atrial fibrillation, and left cardiac thrombus. Results: Multivariate testing revealed a signif icant association of hypertension and diabetes with multiple lacunar i nfarcts and/or leucoaraiosis (hypertension: odds ratio 2,0; 95% confid ence interval 1,04-3,7; diabetes: odds ratio 1,9; 95% confidence inter val 1,01-3,5) whereas for the total group of patients with small-vesse l disease lesions no such effect was found. Among the other tested var iables, only atrial fibrillation/left cardiac thrombus showed a signif icant negative association (odds ratio 0,5; 95% confidence interval 0, 2-0,9) with lacunes/leucoaraiosis. Conclusion: Independent of other ri sk factors and other possible causes of stroke, both hypertension and diabetes appear to be strong determinants of multiple lacunar infarcts and/or leucoaraiosis.