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From the Department of Neurology (Dr. You, H.M. O'Malley, and Dr. Donnan), Austin and Heidelberg Hospitals, University of Melbourne; the Department of Social and Preventive Medicine (Dr. McNeil), Monash University; and the Department of Neurology (Dr. Davis), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
Supported by a grant from the Victorian Health Promotion Foundation and Australian Stroke and Neuroscience Institute, Australia. Dr. You was supported by a Postgraduate Research Scholarship of the Australian National Health and Medical Research Council.
Received September 20, 1994. Accepted in final form December 30, 1994.
Address correspondence and reprint requests to Prof Donnan, Department of Neurology, Austin and Heidelberg Hospitals, Heidelberg, VIC 3084, Australia.
Background and purpose: Lacunar infarction is an important stroke subgroup with unique clinical and pathologic features, but its relative risks for associated risk factors have been rarely documented. To address this matter, we studied 203 consecutive patients with first-ever stroke 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 structured questionnaire and by comparison with age- and sex-matched neighborhood controls. Odds ratios were estimated with adjustment for confounding 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]), current smoking (6.6 [2.9, 14.8]), and diabetes (2.3 [1.0, 5.5]), whereas frequent physical exercise was associated with a significantly decreased risk (0.3 [0.1, 0.7]). There was no risk of lacunar stroke associated with heart disease (odds ratio 1.0 [0.5, 1.9]). Conclusions: Patients with hypertension or diabetes, and those who currently smoke, are at a higher risk of lacunar stroke, whereas those who undertake regular physical exercise may be at lower risk. The high risk associated with hypertension but absent risk with heart disease supports the ``lacunar hypothesis'' of a unique pathophysiologic mechanism for lacunar stroke.
NEUROLOGY 1995;45: 1483-1487
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