TY - JOUR T1 - Risk factor profile of cerebral small vessel disease and its subtypes JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp.2006.103549 AU - Usman Khan AU - Linda Porteous AU - Ahamad Hassan AU - Hugh Markus Y1 - 2007/01/08 UR - http://jnnp.bmj.com/content/early/2007/01/08/jnnp.2006.103549.abstract N2 - Background: The mechanisms of cerebral small vessel disease (SVD) are unclear. Both atherosclerosis and a non-atherosclerotic diffuse arteriopathy have been reported pathologically. Two pathological and radiological subtypes have been suggested: localised atherosclerotic disease in larger perforating arteries causing larger lacunar infarcts without leukoaraiosis, and diffuse disease in smaller arterioles causing multiple smaller lacunar infarcts with leukoaraiosis. If atherosclerosis were important in SVD as a whole or in one particular subtype, one would expect the risk factor profile to be similar to that of cerebral large vessel disease (LVD). Methods: Risk factor profiles were compared in Caucasian stroke patients with SVD (N=414), LVD (N=471) and 734 stroke-free Caucasian population controls. Patients with SVD were subdivided according to the presence or absence of confluent leukoaraiosis, into isolated lacunar infarction (ILI) and ischaemic leukoaraiosis (ILA). Results: Hypertension was commoner in SVD than LVD (OR 3.43(2.32-5.07)p<0.001), whereas hypercholesterolaemia (OR 0.34(0.24–0.48)p<0.001), smoking (OR 0.63(0.44–0.91)p=0.012) myocardial infarction (OR 0.35(0.20–0.59)p<0.001) and peripheral vascular disease (OR 0.32(0.20–0.50)p<0.001) were commoner in LVD. Amongst SVD patients, age (OR 1.11(1.09–1.14)p<0.001) and hypertension (OR 3.32(1.56-7.07)p=0.002) were associated with ILA and hypercholesterolaemia (OR 0.45(0.28–0.74)p=0.002), diabetes (OR 0.42(0.21-0.84)p=0.014) and myocardial infarction (OR 0.18(0.06-0.52)p=0.001) with ILI. Conclusion: SVD has a different risk factor profile from the typical atherosclerotic profile found in LVD, with hypertension being important. There are differences in risk factor profile between the SVD subtypes; the association of ILI with hypercholesterolaemia, diabetes and myocardial infarction may be consistent with a more atherosclerotic aetiology. ER -