RISK-FACTORS FOR LACUNAR INFARCTION SYNDROMES

Background and purpose: Lacunar infarction is an important stroke subg roup with unique clinical and pathologic features but its relative ris ks for associated risk factors have been rarely documented. To address this matter, we studied 203 consecutive patients with first-ever stro ke due to lacunar infarction admitted to four general hospitals during the period 1985 to 1992. Methods: We obtained information concerning risk factor exposure status among the patients by interview using a st ructured questionnaire and by comparison with age- and sex-matched nei ghborhood controls. Odds ratios were estimated with adjustment for con founding variables by using multivariate logistic regression. Results: Significantly increasing the risk of lacunar stroke were hypertension (with an odds ratio of 8.9 [95% confidence intervals 4.2, 18.8]), cur rent smoking (6.6 [2.9, 14.8]), and diabetes (2.3 [1.0, 5.5]), whereas frequent physical exercise was associated with a significantly decrea sed risk (0.3 [0.1, 0.7]). There was no risk of lacunar stroke associa ted with heart disease (odds ratio 1.0 [0.5, 1.9]). Conclusions: Patie nts with hypertension or diabetes, and those who currently smoke, are at a higher risk of lacunar stroke, whereas those who undertake regula r physical exercise may be at lower risk. The high risk associated wit h hypertension but absent risk with heart disease supports the ''lacun ar hypothesis'' of a unique pathophysiologic mechanism for lacunar str oke.