Recurrent vascular events in lacunar stroke patients with metabolic syndrome and/or diabetes

Shuhan Zhu, Leslie A. McClure, Helena Lau, Jose R. Romero, Carole L. White, Viken Babikian, Thanh Nguyen, Oscar R. Benavente, Carlos S. Kase, Aleksandra Pikula

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    13 Scopus citations

    Abstract

    Objectives: We used a prospective clinical trial to examine the risks conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent strokes in the Secondary Prevention of Small Subcortical Strokes (SPS3) study cohort. Methods: The SPS3 trial enrolled 3,020 patients with lacunar strokes. Participants were stratified into groups of METS only, DM only, both, or neither using American Heart Association/National Heart, Lung, and Blood Institute and World Health Organization guidelines. Annualized event rates of strokes, myocardial infarction (MI), and all-cause mortality were calculated, and hazard ratios (HRs) referencing the "neither" group were computed, controlling for significantly associated baseline characteristics. Results: Among 2,999 participants, 25% had METS only, 6% had DM only, 32% had both conditions, and 37% had neither. Over a median of 3.8 years of follow-up, there were 274 recurrent strokes (240 ischemic, 34 hemorrhagic) and 74 MIs; among the 240 ischemic strokes, 134 (56%) were lacunar. The rates of any recurrent stroke (HR 1.7, 95% confidence interval [CI] 1.3-2.3) or lacunar stroke (HR 2.4, 95% CI 1.5-3.7) were significantly higher for those with concurrent METS and DM compared with those who had neither. Risk of incident MI was higher in participants with DM (HR 2.8, 95% CI 1.1-7.0) or concurrent DM and METS (HR 2.6, 95% CI 1.4-4.9). Conclusion: METS and DM were significant comorbid conditions in lacunar stroke patients and they were associated with stroke recurrence. In patients with lacunar infarcts, a vigilant approach to prevent development of DM in those with METS may be a potential strategy to reduce recurrent strokes.

    Original languageEnglish (US)
    Pages (from-to)935-941
    Number of pages7
    JournalNeurology
    Volume85
    Issue number11
    DOIs
    StatePublished - Sep 15 2015

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    ASJC Scopus subject areas

    • Clinical Neurology

    Cite this

    Zhu, S., McClure, L. A., Lau, H., Romero, J. R., White, C. L., Babikian, V., Nguyen, T., Benavente, O. R., Kase, C. S., & Pikula, A. (2015). Recurrent vascular events in lacunar stroke patients with metabolic syndrome and/or diabetes. Neurology, 85(11), 935-941. https://doi.org/10.1212/WNL.0000000000001933