Relation between diabetes and lacunar infarcts
| Study (ref.) | Study population | Subjects (total/diabetic) (n) | Mean age (years) | Diabetes type | Imaging | Outcome and results | P value | Adjustments/matching | Estimated power |
|---|---|---|---|---|---|---|---|---|---|
| General cohorts | |||||||||
| Longstreth et al. (26) | Population based | 3,660/519 | >65 | 2 | MRI | Silent: OR 1.1 (0.8–1.5) | 0.6 | Age, sex, BP, HL, smoking, PVD, creatinine | 1.0 |
| Symptomatic: OR 2.2 (1.1–4.5) | 0.02 | ||||||||
| Vermeer et al. (8) | Population based | 1,077/75 | >60 | 2 | MRI | Silent: OR 0.7 (0.4–1.5) | NS | Age, sex, BP, smoking | 0.8 |
| Symptomatic: OR 2.5 (1.0–5.9) | <0.05 | ||||||||
| Schmidt et al. (13) | Population based | 1,252/114 | 69 | 2 | MRI | Silent: OR 1.4 (0.7–2.7)* | 0.3 | Sex, age, edu, BP, smoking, BMI, HL, PVD | 0.6 |
| Vascular cohorts | |||||||||
| Jorgensen et al. (40) | Stroke | 494/79 | >70 | 2 | CT | Silent: OR 1.4 (0.9–2.4)* | 0.2 | No | 0.8 |
| Konemori (67) | Stroke vs. control | 324/36 | >50 | ND | MRI | Silent: OR 0.8 | NS | Age, sex, BP, HL | 0.5 |
| Symptomatic: OR 2.5 | NS | ||||||||
| Hsu et al. (28) | Stroke and control | 132/20 | >60 | 2 | CT | Symptomatic: OR 12.5 (3.1–57.6) | <0.05 | No | 0.3 |
| Adachi et al. (42) | Stroke | 171/50 | 69 | 2 | MRI | Silent: OR 1.9 (0.9–3.9) | 0.1 | No | 0.5 |
| Revilla et al. (29) | Lacunar infarcts and control | 164/28 | 65 | 2 | CT/MRI | Symptomatic: OR 5.4 (1.5–18.9) | 0.008 | Age, sex, BP, HL, smoking | 0.4 |
| Arauz et al. (27) | Lacunar infarcts | 175/72 | 64 | 2 | MRI | Silent: OR 3.0 (1.3–7.0) | 0.03 | Age, sex, BP, HL, smoking, alcohol, PVD | 0.5 |
| Selvetella et al. (43) | Hypertension | 195/40 | >60 | 2 | MRI | Silent: OR 2.0 (0.9–4.1)* | 0.07 | No | 0.5 |
| Giele et al. (68) | Atherosclerotic vascular disease or risk factors | 308/59 | 58 | ND | MRI | Silent: OR 1.4 (0.7–2.8)* | 0.4 | No | 0.5 |
| Karapanayiotides et al. (30) | Stroke | 4,064/611 | 67 | 2 | MRI | Symptomatic: OR 1.8 (1.3–3.8) | 0.009 | Sex, smoking, HL | 1.0 |
| Sarkar et al. (31) | Stroke | 450/171 | 51 | ND | CT | Symptomatic: OR 2.6 (1.8–3.9) | <0.05 | No | 0.9 |
| Kario et al. (47) | Hypertension | 20/20 | 69 | 2 | MRI | Silent and symptomatic: OR 2.3 (0.6–8.0) | NS | Age, sex, BP | 0.2 |
| Kawamoto et al. (44) | Stroke | 453/40 | 76 | 2 | CT | Symptomatic: OR 0.7 (0.3–1.6) | 0.35 | Age, sex, smoking | 0.5 |
| Outpatient cohorts | |||||||||
| Araki et al. (21) | MRI for any indication | 2,725/159 | 60 | 2 | MRI | Silent: OR 1.0 (0.7–1.4)* | NS | No | 1.0 |
| Kobayashi et al. (22) | Neurologically normal | 933/66 | 58 | ND | MRI | Silent: OR 2.4 (1.2–4.9) | 0.01 | Age, sex, BP, alcohol, PVD | 0.5 |
| Uehara et al. (69) | Neurologically normal | 219/37 | 63 | 2 | MRI | Silent LI white matter: OR 2.3 (0.98–5.6) | 0.06 | Age, sex, BP, HL, smoking, PVD | 0.5 |
| Silent LI in BG: OR 0.7 (0.2–2.1) | 0.6 | ||||||||
| Biessels et al. (11) | Memory clinic | 347/29 | 73 | 2 | MRI | Silent: OR 2.3 (0.9–5.6) | NS | Age, sex | 0.3 |
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/).