Stroke presentation in Type 2 diabetes and the metabolic syndrome

Introduction: The metabolic syndrome (MetS) is associated with macrovascular disease and an altered pattern of cerebrovascular disease. We investigated stroke subtype presentation in Type 2 diabetic (T2D) patients, and analysed patients with and without the MetS. Methods: We performed a retrospective analysis of 243 T2D patients with first presentation of stroke from our Diabetes Centre database. The MetS was diagnosed in patients with T2D and two or more additional risk factors (obesity, low HDL cholesterol, elevated triglycerides or hypertension). We analysed the clinical stroke subtype presentation, using the Oxford classification of stroke, into cortical and lacunar (small vessel disease) stroke. Results: The MetS was diagnosed in 151 T2D patients (62%), with 86 male and 65 female patients (age: 71.8 ± 9.7). Comparing the MetS and non-MetS groups, the distribution of stroke subtypes adjusted for age and sex were: cortical stroke (13.2% versus 15.2%; P = 0.56), lacunar stroke (43.7% versus 43.5%; P = 0.87) and TIA (38.4% versus 39.1%; P = 0.98). Lacunar stroke incidence was significantly higher compared to cortical stroke in both groups (P < 0.001). Conclusion: In this study of T2D patients, lacunar stroke (small vessel disease) was the most common stroke subtype in both patients with and without the MetS.