Table 2—

Relation between diabetes and lacunar infarcts

Study (ref.)Study populationSubjects (total/diabetic) (n)Mean age (years)Diabetes typeImagingOutcome and resultsP valueAdjustments/matchingEstimated power
General cohorts
    Longstreth et al. (26)Population based3,660/519>652MRISilent: OR 1.1 (0.8–1.5)0.6Age, sex, BP, HL, smoking, PVD, creatinine1.0
Symptomatic: OR 2.2 (1.1–4.5)0.02
    Vermeer et al. (8)Population based1,077/75>602MRISilent: OR 0.7 (0.4–1.5)NSAge, sex, BP, smoking0.8
Symptomatic: OR 2.5 (1.0–5.9)<0.05
    Schmidt et al. (13)Population based1,252/114692MRISilent: OR 1.4 (0.7–2.7)*0.3Sex, age, edu, BP, smoking, BMI, HL, PVD0.6
Vascular cohorts
    Jorgensen et al. (40)Stroke494/79>702CTSilent: OR 1.4 (0.9–2.4)*0.2No0.8
    Konemori (67)Stroke vs. control324/36>50NDMRISilent: OR 0.8NSAge, sex, BP, HL0.5
Symptomatic: OR 2.5NS
    Hsu et al. (28)Stroke and control132/20>602CTSymptomatic: OR 12.5 (3.1–57.6)<0.05No0.3
    Adachi et al. (42)Stroke171/50692MRISilent: OR 1.9 (0.9–3.9)0.1No0.5
    Revilla et al. (29)Lacunar infarcts and control164/28652CT/MRISymptomatic: OR 5.4 (1.5–18.9)0.008Age, sex, BP, HL, smoking0.4
    Arauz et al. (27)Lacunar infarcts175/72642MRISilent: OR 3.0 (1.3–7.0)0.03Age, sex, BP, HL, smoking, alcohol, PVD0.5
    Selvetella et al. (43)Hypertension195/40>602MRISilent: OR 2.0 (0.9–4.1)*0.07No0.5
    Giele et al. (68)Atherosclerotic vascular disease or risk factors308/5958NDMRISilent: OR 1.4 (0.7–2.8)*0.4No0.5
    Karapanayiotides et al. (30)Stroke4,064/611672MRISymptomatic: OR 1.8 (1.3–3.8)0.009Sex, smoking, HL1.0
    Sarkar et al. (31)Stroke450/17151NDCTSymptomatic: OR 2.6 (1.8–3.9)<0.05No0.9
    Kario et al. (47)Hypertension20/20692MRISilent and symptomatic: OR 2.3 (0.6–8.0)NSAge, sex, BP0.2
    Kawamoto et al. (44)Stroke453/40762CTSymptomatic: OR 0.7 (0.3–1.6)0.35Age, sex, smoking0.5
Outpatient cohorts
    Araki et al. (21)MRI for any indication2,725/159602MRISilent: OR 1.0 (0.7–1.4)*NSNo1.0
    Kobayashi et al. (22)Neurologically normal933/6658NDMRISilent: OR 2.4 (1.2–4.9)0.01Age, sex, BP, alcohol, PVD0.5
    Uehara et al. (69)Neurologically normal219/37632MRISilent LI white matter: OR 2.3 (0.98–5.6)0.06Age, sex, BP, HL, smoking, PVD0.5
Silent LI in BG: OR 0.7 (0.2–2.1)0.6
    Biessels et al. (11)Memory clinic347/29732MRISilent: OR 2.3 (0.9–5.6)NSAge, sex0.3
  • Studies are listed in chronological order. Study populations: general cohorts, population-based or case-control studies; vascular cohorts, cohort with stroke or other cardiovascular risk factors; outpatient cohorts, neurological outpatients. Diabetes type: 2 (except for the study by Kario et al. [47]), population type classified as predominantly type 2 diabetes (see research design and methods). ND, not determined. Outcome and results: BG, basal ganglia; LI, lacunar infarcts. ORs are presented with 95% CIs in parentheses.

  • *

    * Where possible, we calculated ORs if they were not provided in the original article. P value: NS, not significant. Adjustments/matching: AF, atrial fibrillation; BP, blood pressure (including hypertension, mean arterial pressure, systolic blood pressure, use of antihypertensive drugs, left ventricular hypertrophy, and ankle-to-arm index); edu, education; HL, hyperlipidemia; ICD, ischemic cerebrovascular disease (including transient ischemic attack, stroke, leukoaraiosis, WMLs, and ultrasound examination of carotid or intracranial arteries); PVD, peripheral vascular disease (including peripheral artery disease, coronary artery disease, cardiac disease, congestive heart failure, and electrocardiogram changes). Estimated power: For each study, the power (1 − β) to detect a statistically significant difference between the diabetic and the control group was estimated, assuming an OR for infarcts of 2.0 in the diabetic group and an α of 0.05 with two-sided testing (http://calculators.stat.ucla.edu/powercalc/).