• Santiago Palacio, Leslie A McClure, Oscar R Benavente, Carlos Bazan, Pablo Pergola, and Robert G Hart.
• From the Departments of Neurology (S.P.), Radiology (C.B.), and Medicine (P.P.), University of Texas Health Science Center, San Antonio, TX; University of Alabama at Birmingham (L.A.M.); Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada (O.R.B.); and Department of Medicine (Neurology), McMaster University/Population Health Research Institute Hamilton, Ontario, Canada (R.G.H.). palacios0@uthscsa.edu.
• Stroke. 2014 Sep 1; 45 (9): 2689-94.

Background And PurposeDiabetes mellitus is an independent risk factor for lacunar strokes. Few data are available regarding patient features, infarct location, and recurrent vascular events for patients with diabetes mellitus with lacunar stroke.MethodsWe compared features at study entry and prognosis during 3.6 years of follow-up of patients with diabetes mellitus versus patients without diabetes mellitus with recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial.ResultsAmong the 3020 participants, the prevalence of diabetes mellitus was 37% with a mean duration of 11 years. Diabetes mellitus was independently associated with slightly younger age (63 versus 64 years; P<0.001), Hispanic ethnicity (36% versus 28%; P<0.0001), ischemic heart disease (11% versus 6%; P=0.002), and peripheral vascular disease (5% versus 2%; P<0.001). Patients with diabetes mellitus more frequently had intracranial stenosis ≥50% (P<0.001), infarcts involving the brain stem or cerebellum (P<0.001), and more extensive white matter abnormalities (P<0.001). Patients with diabetes mellitus were almost twice as likely to have a recurrent stroke (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.4-2.3), recurrent ischemic stroke (HR, 1.8; 95% CI, 1.4-2.4), disabling/fatal stroke (HR, 1.8; 95% CI, 1.2-2.9), myocardial infarction (HR, 1.7; 95% CI, 1.0-2.8), and death (HR, 2.1 95% CI, 1.6-2.8) compared with patients without diabetes mellitus.ConclusionsPatients with diabetes mellitus with lacunar stroke have a distinctive clinical profile that includes double the prevalence of systemic and intracranial atherosclerosis, preferential involvement of the posterior circulation, and a poor prognosis for recurrent stroke and death.Clinical Trial Registration Urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00059306.© 2014 American Heart Association, Inc.

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