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Zhang P, Zhang Y. Association of Homocysteine with Acute Stroke and Its Subtypes in the Chinese Population. Neuropsychiatr Dis Treat 2023; 19:1435-1442. [PMID: 37342757 PMCID: PMC10278861 DOI: 10.2147/ndt.s409591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Homocysteine (Hcy) is recognized as a risk factor for stroke. Our study examined the relationship between plasma Hcy levels and stroke, along with its subtypes, among Chinese patients who experienced an acute stroke episode. Patients and Methods We retrospectively enrolled patients with acute stroke and age- and sex-matched healthy controls admitted to the First Affiliated Hospital of Xi'an Jiaotong University from October 2021 to September 2022. Ischemic stroke subtypes were classified using the modified TOAST criteria. Multivariate logistic regression models were employed to probe the associations of plasma Hcy levels with total stroke, ischemic stroke and its subtypes, and hypertensive intracerebral hemorrhage (HICH), and the correlation between plasma Hcy levels and the National Institute of Health Stroke Scale (NIHSS). Results The mean age of the total group was 63 years, with women representing 30.6% (246 individuals). Elevated Hcy levels were significantly associated with total stroke (OR 1.054, 95% CI: 1.038-1.070), HICH (OR 1.040, 95% CI: 1.020-1.060), ischemic stroke (OR 1.049, 95% CI: 1.034-1.065), and the TOAST subtypes of ischemic stroke in large-artery atherosclerosis (LAA) (OR 1.044, 95% CI: 1.028-1.062) and small-artery occlusion (SAO) (OR 1.035, 95% CI: 1.018-1.052), but not with cardioembolic (CE) stroke. Moreover, only in the case of SAO stroke were the Hcy levels positively correlated with the NIHSS score (B=0.030, 95% CI: 0.003-0.056, P=0.030). Conclusion Plasma Hcy levels were found to be positively correlated with the risk of stroke, particularly in the context of LAA, SAO stroke, and HICH. Additionally, Hcy levels demonstrated a positive correlation with stroke severity in patients presenting with SAO stroke. These findings suggest potential clinical implications in stroke prevention, particularly for ischemic stroke (LAA, SAO subtypes) and HICH by employing homocysteine-lowering therapies. Future investigations are warranted to fully elucidate these associations.
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Affiliation(s)
- Panpan Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yurong Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis. PLoS One 2022; 17:e0276087. [PMID: 36227950 PMCID: PMC9560514 DOI: 10.1371/journal.pone.0276087] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. METHODS We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of τ2 through the DerSimonian-Laird method. RESULTS The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00-2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I2 = 99%), particularly because three studies showed significantly large mean differences. CONCLUSION This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
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Clinical Utility of Serum Holotranscobalamin Measurements in Patients with First-Ever Ischemic Stroke. DISEASE MARKERS 2021; 2021:9914298. [PMID: 34545295 PMCID: PMC8449731 DOI: 10.1155/2021/9914298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
Background Whether holotranscobalamin (holoTC) indicates B12 deficiency more sensitively than total vitamin B12 (B12) is unclear. This study is aimed at determining the impact of serum holoTC level as a risk factor for ischemic stroke and investigating its association with disease severity and short-term outcomes. Methods Serum holoTC, total B12, and homocysteine levels were compared between 130 stroke patients and 138 healthy controls. Biomarker level correlations with disease severity and stroke functional outcomes were investigated. Results holoTC levels were lower and homocysteine levels were higher in stroke patients than in healthy controls (P < 0.05). The holoTC/total B12 ratio and homocysteine level significantly predicted ischemic stroke in the multivariable regression analysis (P < 0.05). Along with hyperhomocysteinemia, patients more often had holoTC than total B12 deficiency (6.2% vs. 3.1%). holoTC levels negatively correlated with homocysteine levels (partial R -0.165, P < 0.05) in stroke patients in multiple linear regression analyses, but not total B12 levels. The holoTC level and holoTC/total B12 ratio, but not homocysteine and total B12 levels, negatively correlated with the National Institute of Health Stroke Scale (partial R, -0.405 and -0.207, respectively, P < 0.01). Conclusions Measurements of serum holoTC levels combined with total B12 and homocysteine levels may provide valuable information for predicting ischemic stroke and its severity and short-term outcomes of ischemic stroke patients.
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Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Meta-analysis. TH OPEN 2021; 5:e420-e437. [PMID: 34595387 PMCID: PMC8463136 DOI: 10.1055/s-0041-1735978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Previous studies suggest an association between increased homocysteine (Hcy) and risk of ischemic stroke. Yet, it remains unknown whether a dose-response association exists between Hcy levels and risk of ischemic stroke. Methods Systematic literature searches were performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were studies investigating ischemic stroke risk in an adult population with measured Hcy levels. We computed odds ratios (ORs) for a 5 µmol/L increase in Hcy levels using a random effects meta-analysis. Results In total, 108 studies met the inclusion criteria of which 22 were rated as high-quality studies, and 20 studies included a dose-response analysis. Hcy levels were analyzed either as a continuous or categorical variable. The majority of the studies found an increased risk of ischemic stroke when comparing the highest-to-lowest Hcy strata. A graded association was observed over the Hcy strata, indicating a dose-response association, with the most apparent effect when Hcy levels exceeded approximately 15 µmol/L. No studies explored a potential nonlinear association between Hcy levels and ischemic stroke. Six studies were included in a meta-analysis, showing an OR of 1.43 (95% confidence interval [CI]: 1.28-1.61) per 5 µmol/L increase in Hcy levels. Conclusion This review and meta-analysis indicate a dose-response association between Hcy levels and ischemic stroke. An evident increase in effect measures was observed when Hcy levels exceeded 15 µmol/L, indicating a nonlinear association between ischemic stroke and Hcy levels. This nonlinear association warrants further study. This study is registered with clinical trial ( https://www.crd.york.ac.uk/prospero/ ; unique identifier: CRD42019130371).
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Affiliation(s)
- Marte Holmen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan F. H. Arendt
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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Huang S, Cai J, Tian Y. The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis. Front Syst Neurosci 2021; 14:600582. [PMID: 33643003 PMCID: PMC7907516 DOI: 10.3389/fnsys.2020.600582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background: This comprehensive meta-analysis aimed to assess whether an increased homocysteine (Hcy) level is an independent predictor of unfavorable outcomes in acute ischemic stroke (AIS) patients. Methods: A comprehensive literature search was conducted up to August 1, 2020 to collect studies reporting Hcy levels in AIS patients. We analyzed all the data using Review Manager 5.3 software. Results: Seventeen studies with 15,636 AIS patients were selected for evaluation. A higher Hcy level was associated with a poorer survival outcome (OR 1.43, 95% CI: 1.25–1.63). Compared with the AIS group, Hcy levels were significantly lower in the healthy control patients, with an SMD of 5.11 and 95% CI (1.87–8.35). Analysis of the different subgroups of AIS demonstrated significant associations between high Hcy levels and survival outcomes only in Caucasian and Asian patients. Moreover, whereas high Hcy levels were closely associated with gender, B12 deficiency, smoking, and patients who received tissue plasminogen activator treatment, no significant difference was found between increased Hcy levels and age, drinking, hypertension, diabetes mellitus, and hyperlipidemia. In addition, the cut-off value (20.0 μmol/L) might be an optimum cut-off index for AIS patients in clinical practice. Conclusion: This meta-analysis reveals that the Hcy level may serve as an independent predictor for unfavorable survival outcomes in AIS patients, particularly in Caucasian and Asian AIS patients. Further studies can be conducted to clarify this relationship.
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Affiliation(s)
- Shengming Huang
- Department of Neurology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China
| | - Jirui Cai
- Department of Cardiology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China
| | - Yuejun Tian
- Department of Neurology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China.,Institute of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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Omer Sultan M, Farooque U, Javed R, Khan MI, Karimi S, Abdul Sattar R, Cheema O. Correlation of Homocysteine Level and Age in Patients with Ischemic Stroke. Cureus 2020; 12:e7785. [PMID: 32461857 PMCID: PMC7243624 DOI: 10.7759/cureus.7785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Hyperhomocysteinemia is associated with atherosclerosis, as it can be seen in inborn errors of methionine metabolism. Likewise, many studies have also reported more modest increases in serum homocysteine levels in other atherosclerotic disorders like cardiovascular disease and all types of stroke with a positive correlation with age. But overall literature is controversial. Therefore, this study is being conducted to further investigate the relationship between homocysteine levels and age in patients, especially those with ischemic stroke. Material and methods This cross-sectional study is conducted at a major hospital in Karachi in which all patients with ischemic stroke, diagnosed within 24 hours on CT, and age 40-75 years of both genders were enrolled for six months. Other demographics were also noted like gender, smoking status, and comorbidities (diabetes mellitus [DM], hypertension [HTN]). The homocysteine level was also checked by collecting non-fasting blood. Vitamin B12 level was not checked. The age, weight, height, body mass index (BMI), and homocysteine level’s means and standard deviations and the gender, DM, hypertension, and smoking status frequencies and percentages were calculated. The correlation coefficient of homocysteine level and age was also calculated. Stratification was done to see the effects of gender, BMI, DM, and HTN on homocysteine levels by applying the chi-square test. Results The mean age of the patients was 55.60 ± 11.45 years. Gender distribution showed that 111 (62.40%) patients were male, and 67 (37.60%) patients were female. Diabetic, hypertensive, and smoking status of the patients was 58 (32.60%), 96 (53.90%), and 53 (29.80%), respectively. The mean homocysteine level was 14.61, with a standard deviation of 1.47. Pearson’s correlation test showed that there is no statistically significant correlation between homocysteine levels and age. But a significant linear relationship was found of homocysteine levels with DM and HTN. Conclusion Further investigation of the relationship of homocysteine levels with age, diabetes mellitus, and hypertension, and the role of homocysteine as a risk factor for ischemic stroke should be carried out on a larger scale to prove its accuracy. The benefits of screening for homocysteine levels also need to be studied in the elderly, especially those with diabetes mellitus and hypertension, which can lead to timely prevention of strokes and ischemic heart disease with vitamin B supplements, and other appropriate interventions.
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Affiliation(s)
| | | | - Rafay Javed
- Internal Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, PAK
| | - Muhammad I Khan
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Sundas Karimi
- General Surgery, Combined Military Hospital, Karachi, PAK
| | | | - Omer Cheema
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Luo Y, Jin H, Guo ZN, Zhang P, Zhang LY, Chen J, Yu Y, Wang Y, Liu J, He QY, Sun X, Yang Y. Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients. Front Neurol 2019; 10:592. [PMID: 31249548 PMCID: PMC6584786 DOI: 10.3389/fneur.2019.00592] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/20/2019] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose: Hyperhomocysteinemia (Hhcy) is a well-known risk factor for ischemic stroke. However, the role of Hhcy in the clinical outcome of ischemic stroke has not been fully elucidated. In addition, previous studies have found that Hhcy was implicated in the disruption of the blood-brain barrier, which may increase the risk of hemorrhagic transformation (HT) after thrombolysis. Thus, the aim of this study was to investigate the effect of Hhcy on the clinical outcome and HT after thrombolysis in ischemic stroke patients. Methods: Patients who were diagnosed with ischemic stroke and received intravenous thrombolytic therapy between January 2016 and September 2018 were included in this study. Multivariate logistic regression analysis was used to assess the association between Hhcy, clinical outcome, and HT after thrombolysis. Furthermore, the potential interaction between Hhcy and hypertension on the clinical outcome and HT after thrombolysis was also assessed. Results: Of 568 patients, 455 (80.1%) had Hhcy, 66 (11.6%) had HT, and 219 (38.6%) had poor outcome. Patients with Hhcy had a higher incidence of poor outcome than the patients with non-Hhcy (40.9 vs. 29.2%, p = 0.022). However, there was no significant difference in the incidence of HT (11.9 vs. 10.6%, p = 0.711) between patients with Hhcy and non-Hhcy. After adjustment for major covariates, multivariate logistic regression analysis disclosed that Hhcy was independently associated with increased risk of poor outcome (OR = 1.760; 95% CI: 1.069–2.896) but was not associated with the risk of HT (OR = 1.017; 95% CI: 0.495–2.087). In addition, we found no significant interaction between Hhcy and hypertension on the clinical outcome (p = 0.513) or HT (p = 0.170) after thrombolysis. Conclusion: We found that Hhcy was an independent risk factor for poor outcome, but not an independent risk factor for HT after thrombolysis in ischemic stroke patients. In addition, there was no significant interaction of Hhcy and hypertension on the clinical outcome or HT after thrombolysis.
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Affiliation(s)
- Yun Luo
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Hang Jin
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Zhen-Ni Guo
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, China
| | - Peng Zhang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Li-Yue Zhang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Jie Chen
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Yao Yu
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Yan Wang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Jie Liu
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Qian-Yan He
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Xin Sun
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
| | - Yi Yang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Chang Chun, China
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Zheng X, Guo D, Peng H, Zhong C, Bu X, Xu T, Zhu Z, Wang A, Chen J, Xu T, Peng Y, Li Q, Ju Z, Geng D, He J, Zhang Y. Platelet counts affect the prognostic value of homocysteine in acute ischemic stroke patients. Atherosclerosis 2019; 285:163-169. [DOI: 10.1016/j.atherosclerosis.2019.04.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/25/2019] [Accepted: 04/03/2019] [Indexed: 11/15/2022]
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Tinelli C, Di Pino A, Ficulle E, Marcelli S, Feligioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr 2019; 6:49. [PMID: 31069230 PMCID: PMC6491750 DOI: 10.3389/fnut.2019.00049] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/03/2019] [Indexed: 01/08/2023] Open
Abstract
Hyperhomocysteinemia is recognized as a risk factor for several diseases, including cardiovascular and neurological conditions. Homocysteine (HCys) is a key metabolite involved in the biosynthesis and metabolism of methionine (Met), which plays a pivotal role in the physiological cell's life cycle. The biochemistry of Met is finely regulated by several enzymes that control HCys concentration. Indeed, balanced activity among the enzymes is essential for the cell's well-being, while its malfunction could raise HCys concentration which can lead to the onset of several pathological conditions. The HCys concentration increase seems to be caused mainly by the widely diffused polymorphisms of several enzymes. Nowadays, a blood test can easily detect elevated concentrations of HCys, referred to as Hyperhomocysteinemia (HHCys). Prolonged exposure to this condition can lead to the onset of cardiovascular disease and can lead to the development of atherosclerosis, stroke, inflammatory syndromes like osteoporosis and rheumatism, as well as neuronal pathologies including Alzheimer's and Parkinson's diseases. In this review, we analyzed the literature of several pathological conditions in which the molecular pathways of HHCys are involved. Interestingly, several observations indicate that the calibrated assumption of correct doses of vitamins such as folic acid, vitamin B6, vitamin B12, and betaine may control HHCys-related conditions.
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Affiliation(s)
- Caterina Tinelli
- Golgi Cenci Foundation, Abbiategrasso, Italy
- Laboratory of Neuronal Cell Signaling, EBRI Rita Levi-Montalcini Foundation, Rome, Italy
| | - Antonella Di Pino
- Laboratory of Neuronal Cell Signaling, EBRI Rita Levi-Montalcini Foundation, Rome, Italy
| | - Elena Ficulle
- Laboratory of Neurobiology in Translational Medicine, Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - Serena Marcelli
- Laboratory of Neuronal Cell Signaling, EBRI Rita Levi-Montalcini Foundation, Rome, Italy
| | - Marco Feligioni
- Laboratory of Neuronal Cell Signaling, EBRI Rita Levi-Montalcini Foundation, Rome, Italy
- Laboratory of Neurobiology in Translational Medicine, Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
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Moretti R, Caruso P. The Controversial Role of Homocysteine in Neurology: From Labs to Clinical Practice. Int J Mol Sci 2019; 20:ijms20010231. [PMID: 30626145 PMCID: PMC6337226 DOI: 10.3390/ijms20010231] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing amino acid that is generated during methionine metabolism. Physiologic Hcy levels are determined primarily by dietary intake and vitamin status. Elevated plasma levels of Hcy can be caused by deficiency of either vitamin B12 or folate. Hyperhomocysteinemia (HHcy) can be responsible of different systemic and neurological disease. Actually, HHcy has been considered as a risk factor for systemic atherosclerosis and cardiovascular disease (CVD) and HHcy has been reported in many neurologic disorders including cognitive impairment and stroke, independent of long-recognized factors such as hyperlipidemia, hypertension, diabetes mellitus, and smoking. HHcy is typically defined as levels >15 micromol/L. Treatment of hyperhomocysteinemia with folic acid and B vitamins seems to be effective in the prevention of the development of atherosclerosis, CVD, and strokes. However, data from literature show controversial results regarding the significance of homocysteine as a risk factor for CVD and stroke and whether patients should be routinely screened for homocysteine. HHcy-induced oxidative stress, endothelial dysfunction, inflammation, smooth muscle cell proliferation, and endoplasmic reticulum (ER) stress have been considered to play an important role in the pathogenesis of several diseases including atherosclerosis and stroke. The aim of our research is to review the possible role of HHcy in neurodegenerative disease and stroke and to understand its pathogenesis.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy.
| | - Paola Caruso
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy.
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Rościszewska-Żukowska I, Zając-Mnich M, Janik P. Characteristics and clinical correlates of white matter changes in brain magnetic resonance of migraine females. Neurol Neurochir Pol 2018; 52:695-703. [DOI: 10.1016/j.pjnns.2018.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
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Harris S, Rasyid A, Kurniawan M, Mesiano T, Hidayat R. Association of High Blood Homocysteine and Risk of Increased Severity of Ischemic Stroke Events. Int J Angiol 2018; 28:34-38. [PMID: 30880891 DOI: 10.1055/s-0038-1667141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Stroke is the leading cause of death and disability in the world as well as in Indonesia. Initial stroke severity is an important factor that affects short- and long-term stroke outcomes. This cross-sectional study was conducted in Cipto Mangunkusumo Hospital from July 2017 to January 2018 to investigate the factors that affect stroke severity. A total of 77 acute ischemic stroke patients were divided into three groups, which include low blood homocysteine levels (< 9 μmol/L), moderate blood homocysteine levels (9-15 μmol/L), and high blood homocysteine levels (> 15 μmol/L). The acquired data were analyzed using Kruskal-Wallis test and a significant difference of initial National Institute of Health Stroke Scale (NIHSS) and blood homocysteine levels ( H = 13.328, p = 0.001) were seen, with a mean rank of 25.86 for low blood homocysteine levels, 33.69 for moderate blood homocysteine levels, and 48.94 for high blood homocysteine levels. The patients were then divided into two groups based on the NIHSS (≤5 and > 5) to calculate the risk correlation of blood homocysteine levels and NIHSS by using regression. We found that patients with high blood homocysteine levels had 14.4 times higher risk of having NIHSS > 5 compared with those with low blood homocysteine levels ( p = 0.002, 95% confidence interval [CI] [2.714-76.407]), and 3.9 times higher risk compared with those with moderate blood homocysteine levels ( p = 0.011, 95% CI [1.371-11.246]). We concluded that homocysteine is a risk factor for a higher stroke severity. Future studies to evaluate the usefulness of homocysteine-lowering therapy in stroke patients are recommended.
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Affiliation(s)
- Salim Harris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Al Rasyid
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Taufik Mesiano
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Gungor L, Polat M, Ozberk MB, Avci B, Abur U. Which Ischemic Stroke Subtype Is Associated with Hyperhomocysteinemia? J Stroke Cerebrovasc Dis 2018; 27:1921-1929. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/05/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
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14
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Zhou Z, Liang Y, Qu H, Zhao M, Guo F, Zhao C, Teng W. Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis. Sci Rep 2018; 8:2568. [PMID: 29416106 PMCID: PMC5803270 DOI: 10.1038/s41598-018-21019-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/29/2018] [Indexed: 12/27/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has the highest mortality rate in all strokes. However, controversy still exists concerning the association between plasma homocysteine (Hcy) and ICH. A systematic review and meta-analysis was conducted using Pubmed, Embase, and Web of Science up to April 18, 2017. Standard mean difference (SMD) for mean differences of plasma Hcy levels with 95% confidence intervals (CI) was calculated. Seven studies including 667 ICH patients and 1821 ischemic stroke patients were identified for meta-analysis. Our results showed that Hcy levels in ICH patients were significantly higher than those in healthy controls (SMD = 0.59, 95% CI = 0.51–0.68, P < 0.001); no statistic differences were found in the comparisons of Hcy levels between ICH and ischemic stroke (SMD = −0.03, 95% CI = −0.13–0.06, P > 0.05); further subgroup analysis of ethnicity (Asians: SMD = 0.57, 95% CI = 0.48–0.66, P < 0.001; Caucasians: SMD = 0.77, 95% CI = 0.51–1.02, P < 0.001) and sample size (small samples: SMD = 0.55, 95% CI = 0.30–0.80, P < 0.001; large samples size: SMD = 0.60, 95% CI = 0.51–0.69, P < 0.001) in relation to Hcy levels between ICH and healthy controls did not change these results. In conclusion, Hcy level may be an aggravating factor in atherosclerosis, which is positively associated with high risk of ICH. Race-specific differences between Asians and Caucasians have no impact on the risk of ICH.
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Affiliation(s)
- Zhike Zhou
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Yifan Liang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China
| | - Huiling Qu
- 3Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, 110016, Liaoning, PR China
| | - Mei Zhao
- Department of Cardiology, The Shengjing Affiliated Hospital, China Medical University, Shenyang, 110004, Liaoning, PR China
| | - Feng Guo
- Department of Neurology, Fuxin Central Hospital, fuxin, 123000, Liaoning, PR China
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, PR China.
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15
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Hsu CY, Chiu SW, Hong KS, Saver JL, Wu YL, Lee JD, Lee M, Ovbiagele B. Folic Acid in Stroke Prevention in Countries without Mandatory Folic Acid Food Fortification: A Meta-Analysis of Randomized Controlled Trials. J Stroke 2018; 20:99-109. [PMID: 29402063 PMCID: PMC5836580 DOI: 10.5853/jos.2017.01522] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Additional folic acid (FA) treatment appears to have a neutral effect on reducing vascular risk in countries that mandate FA fortification of food (e.g., USA and Canada). However, it is uncertain whether FA therapy reduces stroke risk in countries without FA food fortification. The purpose of this study was to comprehensively evaluate the efficacy of FA therapy on stroke prevention in countries without FA food fortification. METHODS PubMed, EMBASE, and clinicaltrials.gov from January 1966 to August 2016 were searched to identify relevant studies. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between FA supplementation and risk of stroke, after pooling data across trials in a random-effects model. RESULTS The search identified 13 randomized controlled trials (RCTs) involving treatment with FA that had enrolled 65,812 participants, all of which stroke was reported as an outcome measure. After all 13 RCTs were pooled, FA therapy versus control was associated with a lower risk of any future stroke (RR, 0.85; 95% CI, 0.77 to 0.95). FA alone or combination of FA and minimal cyanocobalamin (≤0.05 mg/day) was associated with a lower risk of future stroke (RR, 0.75; 95% CI, 0.66 to 0.86) whereas combination of FA and cyanocobalamin (≥0.4 mg/day) was not associated with a lower risk of future stroke (RR, 0.95; 95% CI, 0.86 to 1.05). CONCLUSIONS FA supplement reduced stroke in countries without mandatory FA food fortification. The benefit was found mostly in patients receiving FA alone or combination of FA and minimal cyanocobalamin.
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Affiliation(s)
- Chia-Yu Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Shao-Wen Chiu
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeffrey L Saver
- Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yi-Ling Wu
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
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16
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Ren JR, Ren SH, Ning B, Wu J, Cao Y, Ding XM, Zhen ZG, Hao XD, Wang S. Hyperhomocysteinemia as a Risk Factor for Saccular Intracranial Aneurysm: A Cohort Study in a Chinese Han Population. J Stroke Cerebrovasc Dis 2017; 26:2720-2726. [PMID: 28943219 DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/15/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We evaluated the possible relationships between serum total homocysteine and folate and Vitamin B12 in patients with intracranial aneurysm. METHODS We enrolled consecutive patients with intracranial aneurysm from the Han population who were admitted to the hospital, as well as control subjects who received medical examination on an outpatient basis. The serum total homocysteine, folate, and Vitamin B12 levels were measured in patients with intracranial aneurysm and the control group, and the associations between those factors were analyzed using multivariate logistic analysis. RESULTS A total of 140 patients with intracranial aneurysm and 140 control subjects were enrolled from July 2014 to December 2015. The mean serum total homocysteine level in the patient group (19.98 ± 10.84 µmol/L) was significantly higher than that in the control group (15.13 ± 5.55 µmol/L, P < .001). The serum total homocysteine level was negatively correlated with folate and Vitamin B12 levels (r = -.349, P < .001; r = -.531, P < .001, respectively) in the patient group. Homocysteine had an adjusted odds ratio of 2.196 (95% confidence interval: 1.188-4.057, P = .012) for the development of intracranial aneurysm. CONCLUSIONS The present study provides evidence regarding the association between serum total homocysteine and folate and Vitamin B12 in patients with intracranial aneurysm. Hyperhomocysteinemia is an independent risk factor for intracranial aneurysm, and folate and Vitamin B12 are protective against intracranial aneurysm due to their roles in regulating the metabolism of homocysteine.
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Affiliation(s)
- Jin-Rui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China; Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Shao-Hua Ren
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Bo Ning
- Department of Neurosurgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong 510220, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Xin-Min Ding
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Zi-Gang Zhen
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Xu-Dong Hao
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China.
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17
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Wang W, Gao C, Yu C, Liu S, Hou D, Wang Y, Wang C, Mo L, Wu J. No Association between Elevated Total Homocysteine Levels and Functional Outcome in Elderly Patients with Acute Cerebral Infarction. Front Aging Neurosci 2017; 9:70. [PMID: 28377713 PMCID: PMC5359234 DOI: 10.3389/fnagi.2017.00070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background: An elevated plasma total homocysteine (tHcy) level is an independent risk factor for vascular events. The aim of the present study was to investigate the association between tHcy levels in the acute phase of cerebral infarction and functional outcome among elderly patients. Methods: Between October 2009 and December 2012, we recruited 594 elderly patients (age > 75) with first-onset acute cerebral infarction who were consecutively admitted to the Department of Neurology of Tianjin Huanhu Hospital, China. Levels of tHcy and other biochemical values were measured within 24 h after admission. tHcy values were classified according to quartiles (<9.94; 9.94 to <12.7; 12.7 to <16.8; and ≥16.8 μmol/L). We examined the relationship between tHcy levels at admission and modified Rankin Scale scores (mRS) using univariate and multivariate analyses. Patients were followed up at 3 months and 1 year after stroke. Results: Within 3 months after stroke, 64 patients died, 37 had recurrent ischemic stroke, and 22 were lost to follow-up; thus, 471 patients were reviewed and analyzed. By the time of the 1-year follow-up, an additional 48 patients had died, 44 had recurrent ischemic stroke, and 40 had been lost to follow-up; the remaining 339 patients were thus reviewed and analyzed. Elevated tHcy levels were not associated with functional outcome among elderly patients with acute cerebral infarction (p > 0.05). Only the National Institutes of Health Stroke Scale score was associated with a poor outcome after adjusting for confounders at 3 months and 1 year (adjusted odds ratio, 1.38; 95% CI, 1.28–1.49; p < 0.01; adjusted odds ratio, 1.34; 95% CI, 1.25–1.44; p < 0.01, respectively). Conclusion: Among elderly patients with acute cerebral infarction, elevated tHcy at admission was not a predictive factor of outcome at 3 months and 1 year after stroke onset.
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Affiliation(s)
- Wanjun Wang
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Chunlin Gao
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Changshen Yu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Shoufeng Liu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Dongzhe Hou
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Yajing Wang
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Chen Wang
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Lidong Mo
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases Tianjin, China
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18
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Piccardi B, Giralt D, Bustamante A, Llombart V, García-Berrocoso T, Inzitari D, Montaner J. Blood markers of inflammation and endothelial dysfunction in cardioembolic stroke: systematic review and meta-analysis. Biomarkers 2017; 22:200-209. [PMID: 28117601 DOI: 10.1080/1354750x.2017.1286689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
CONTEXT Various processes including inflammation and endothelial dysfunction have been implicated in the pathogenesis of cardioembolic (CE) strokes. OBJECTIVE To review the evidence and investigate the association between immune-inflammatory biomarkers and CE strokes versus other stroke subtypes. METHODS We systematically reviewed the literature (sources: MEDLINE, web-based register http://stroke-biomarkers.com , reference lists) with quality assessment and meta-analysis of selected articles. RESULTS The most consistent association was found between C-reactive protein (CRP) and CE strokes when compared to other stroke subtypes (standardized mean difference 0.223 (0.116, 0.343); p < 0.001) Conclusions: Our findings confirm a possible association between selected inflammatory biomarkers and CE stroke.
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Affiliation(s)
- Benedetta Piccardi
- a Neuroscience Section, Department of Neurofarba , University of Florence , Florence , Italy
| | - Dolors Giralt
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Alejandro Bustamante
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Victor Llombart
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Teresa García-Berrocoso
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Domenico Inzitari
- a Neuroscience Section, Department of Neurofarba , University of Florence , Florence , Italy.,c Institute of Neuroscience, Italian National Research Council , Florence , Italy
| | - Joan Montaner
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
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19
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Forti P, Maioli F, Arnone G, Coveri M, Pirazzoli GL, Zoli M, Procaccianti G. Homocysteinemia and early outcome of acute ischemic stroke in elderly patients. Brain Behav 2016; 6:e00460. [PMID: 27096104 PMCID: PMC4828585 DOI: 10.1002/brb3.460] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/23/2016] [Accepted: 02/28/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Plasma total homocysteine (tHcy) is a risk factor for ischemic stroke (IS) but its relationship with IS outcome is uncertain. Moreover, previous studies underrepresented older IS patients, although risk of both hyperhomocysteinemia and IS increases with age. We investigated whether, in elderly patients with acute IS, tHcy measured on admission to the Stroke Unit (SU) is an independent predictor of SU discharge outcomes. MATERIALS AND METHODS Data are for 644 consecutive patients aged 80.3 ± 8.7 years, admitted to an Italian SU with diagnosis of acute IS. Plasma tHcy was measured on SU admission. Investigated outcomes included mortality during SU stay and poor functional status (modified Rankin Scale score ≥3) at SU discharge for survivors. The association of plasma tHcy with the study outcomes was assessed using Odds Ratios (OR) and their corresponding 95% confidence intervals (95%CI) from logistic regression models adjusted for demographics, pre-stroke features, IS severity, and laboratory data on SU admission (serum C-reactive protein, serum albumin, and renal function). RESULTS Median plasma tHcy was 16.7 μmol/L (interquartile range, 13.0-23.3 μmol/L). Outcome incidence was 5.3% for mortality and 49.7% for poor functional status. Plasma tHcy was unrelated to mortality in both univariate and multivariable-adjusted analyses. Conversely, plasma tHcy was associated with poor functional status of survivors in univariate analyses (P = 0.014). Multivariable-adjusted analyses showed that, compared to normal homocysteinemia (tHcy <16 μmol/L), risk of being discharged with poor functional status significantly increased for moderate (tHcy ≥30 mol/L) but not mild (16.0-29.9 μmol/L) hyperhomocysteinemia. CONCLUSIONS In elderly patients with acute IS, high admission plasma tHcy is unrelated to mortality during SU stay but is an independent predictor of poor functional status at SU discharge in survivors. The association, however, is limited to patients with moderate hyperhomocysteinemia.
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Affiliation(s)
- Paola Forti
- Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna Italy
| | - Fabiola Maioli
- Geriatric Stroke Unit Medical Department Maggiore Hospital Bologna Italy
| | - Giorgia Arnone
- Geriatric Stroke Unit Medical Department Maggiore Hospital Bologna Italy
| | - Maura Coveri
- Geriatric Stroke Unit Medical Department Maggiore Hospital Bologna Italy
| | - Gian Luca Pirazzoli
- Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna Italy
| | - Gaetano Procaccianti
- Neurology Stroke Unit Institute of Neurological Sciences (IRCCS) Maggiore Hospital Bologna Italy
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20
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Maestrini I, Ducroquet A, Moulin S, Leys D, Cordonnier C, Bordet R. Blood biomarkers in the early stage of cerebral ischemia. Rev Neurol (Paris) 2016; 172:198-219. [PMID: 26988891 DOI: 10.1016/j.neurol.2016.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/29/2015] [Indexed: 01/25/2023]
Abstract
In ischemic stroke patients, blood-based biomarkers may be applied for the diagnosis of ischemic origin and subtype, prediction of outcomes and targeted treatment in selected patients. Knowledge of the pathophysiology of cerebral ischemia has led to the evaluation of proteins, neurotransmitters, nucleic acids and lipids as potential biomarkers. The present report focuses on the role of blood-based biomarkers in the early stage of ischemic stroke-within 72h of its onset-as gleaned from studies published in English in such patients. Despite growing interest in their potential role in clinical practice, the application of biomarkers for the management of cerebral ischemia is not currently recommended by guidelines. However, there are some promising clinical biomarkers, as well as the N-methyl-d-aspartate (NMDA) peptide and NMDA-receptor (R) autoantibodies that appear to identify the ischemic nature of stroke, and the glial fibrillary acidic protein (GFAP) that might be able to discriminate between acute ischemic and hemorrhagic strokes. Moreover, genomics and proteomics allow the characterization of differences in gene expression, and protein and metabolite production, in ischemic stroke patients compared with controls and, thus, may help to identify novel markers with sufficient sensitivity and specificity. Additional studies to validate promising biomarkers and to identify novel biomarkers are needed.
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Affiliation(s)
- I Maestrini
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France
| | - A Ducroquet
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France
| | - S Moulin
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France
| | - D Leys
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France.
| | - C Cordonnier
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France
| | - R Bordet
- Inserm U 1171, Department of Neurology, University of Lille, UDSL, CHU Lille, 59000 Lille, France
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21
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Zhong C, Xu T, Xu T, Peng Y, Wang A, Wang J, Peng H, Li Q, Geng D, Zhang D, Zhang Y, Zhang Y, Gao X, He J. Plasma Homocysteine and Prognosis of Acute Ischemic Stroke: a Gender-Specific Analysis From CATIS Randomized Clinical Trial. Mol Neurobiol 2016; 54:2022-2030. [PMID: 26910818 DOI: 10.1007/s12035-016-9799-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022]
Abstract
Elevated total homocysteine level (tHcy) has been hypothesized to be associated with morbidity and mortality of stroke; however, results regarding the association between plasma tHcy status and prognosis of acute ischemic stroke are inconsistent. Moreover, the gender effect on this association has yet to be explored. We thus prospectively investigated whether higher tHcy concentrations predicted poor stroke prognosis in Chinese adults. A total of 3309 acute ischemic stroke patients were included in this prospective multicenter study from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Baseline tHcy concentrations were quantitatively determined via enzymatic cycling assay. The primary outcome was a combination of death and major disability at 3 months (modified Rankin scale scores 3-6) after hospitalization. Multivariate logistic regression models with restricted cubic splines were used to determine the association between baseline plasma tHcy and the subsequent outcome. Higher plasma tHcy concentrations were associated with increased risks of the primary outcome in women but not in men (P interaction = 0.016). Adjusted odds ratios comparing two extreme tHcy quartiles were 1.83 (95 % confidence interval 1.12-2.98; P trend = 0.02) in women and 0.87 (95 % confidence interval 0.61-1.25; P trend = 0.37) in men. The significant association between baseline tHcy status and stroke prognosis in women, but not in men, persisted in further subgroup analyses, stratified by age, baseline systolic blood pressure, and other pre-specified factors. Elevated tHcy is positively associated with poor prognosis of acute ischemic stroke in women, but not in men. Further studies are needed to replicate our findings and to clarify the potential sex-specific mechanisms.
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Affiliation(s)
- Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.,Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Jinchao Wang
- Department of Neurology, Yutian County Hospital, Hebei, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Qunwei Li
- Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China
| | - Deqin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China
| | - Dongsheng Zhang
- Department of Neurology and Cardiology, Dongping County People's Hospital, Dongping, Shandong, China
| | - Yuming Zhang
- Department of Neurology, Wenshang County Hospital of Traditional Chinese Medicine, Shandong, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China. .,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Xiang Gao
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA.
| | - Jiang He
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China. .,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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22
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Shi Z, Guan Y, Huo YR, Liu S, Zhang M, Lu H, Yue W, Wang J, Ji Y. Elevated Total Homocysteine Levels in Acute Ischemic Stroke Are Associated With Long-Term Mortality. Stroke 2015. [PMID: 26199315 PMCID: PMC4542568 DOI: 10.1161/strokeaha.115.009136] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose— Total homocysteine (tHcy) levels are associated with secondary vascular events and mortality after stroke. The aim of this study was to investigate whether tHcy levels in the acute phase of a stroke contribute to the recurrence of cerebro-cardiovascular events and mortality. Methods— A total of 3799 patients were recruited after hospital admission for acute ischemic stroke. Levels of tHcy were measured within 24 hours after primary admission. Patients were followed for a median of 48 months. Results— During the follow-up period, 233 (6.1%) patients died. After adjustment for age, smoking status, diabetes mellitus, and other cardiovascular risk factors, patients in the highest tHcy quartile (>18.6 μmol/L) had a 1.61-fold increased risk of death (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.03–2.53) compared with patients in the lowest quartile (≤10 μmol/L). Further subgroup analysis showed that this correlation was only significant in the large-artery atherosclerosis stroke subtype (adjusted HR, 1.80; 95% CI, 1.05–3.07); this correlation was not significant in the small-vessel occlusion subtype (adjusted HR, 0.80; 95% CI, 0.30–2.12). The risk of stroke-related mortality was 2.27-fold higher for patients in the third tHcy quartile (adjusted HR, 2.27; 95% CI, 1.06–4.86) and 2.15-fold more likely for patients in the fourth quartile (adjusted HR, 2.15; 95% CI, 1.01–4.63) than for patients in the lowest tHcy quartile. The risk of cardiovascular-related mortality and the risk of recurrent ischemic stroke were not associated with tHcy levels. Conclusions— Our findings suggest that elevated tHcy levels in the acute phase of an ischemic stroke can predict mortality, especially in stroke patients with the large-vessel atherosclerosis subtype.
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Affiliation(s)
- Zhihong Shi
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Yalin Guan
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Ya Ruth Huo
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Shuling Liu
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Meilin Zhang
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Hui Lu
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Wei Yue
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Jinhuan Wang
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.)
| | - Yong Ji
- From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.).
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Eltayeb AA, Askar GA, Abu Faddan NH, Kamal TM. Prothrombotic risk factors and antithrombotic therapy in children with ischemic stroke. Ther Adv Neurol Disord 2015; 8:71-81. [PMID: 25922619 PMCID: PMC4356662 DOI: 10.1177/1756285615573690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Congenital and acquired prothrombotic disorders have been highlighted in a recent series of cerebrovascular stroke (CVS), with a controversial role in pathogenesis. The aim is to study some prothrombotic risk factors [activated protein C (APC) resistance, von Willebrand factor (vWF), anticardiolpin (ACL) antibodies and plasma homocysteine] in children with ischemic stroke, and to evaluate the role of aspirin and low molecular weight heparin (LMWH) in its management in relation to outcome. METHODS A total of 37 cases aged from 1 month to 15 years ( mean ± standard deviation 26.2 ± 35.7 months), diagnosed as ischemic stroke (>24 hours) were recruited. Complete blood count, prothrombin time and concentration, partial thromboplastin time, serum electrolytes, random blood sugar, C-reactive protein, electrocardiogram and echocardiography were done. Levels of APC resistance, vWF, ACL antibodies [immunoglobulin G (IgG) and immunoglobulin M (IgM)] and plasma homocysteine were estimated. A total of 25 cases received aspirin 3-5 mg /kg/d and 12 patients received LMWH as initial dose at 75 international units (IU)/kg subcutaneously (SC) then 10-25 IU/kg/day for 15 days in a nonrandomized fashion. RESULTS The levels of APC resistance, vWF, ACL antibodies (IgG and IgM) and plasma homocysteine were significantly higher in stroke cases than in controls. There was no significant difference between cases treated with aspirin and those with LMWH in all prothrombotic factors. Significant positive correlations were found between vWF and ACL antibodies (IgG and IgM) levels before treatment. Significant decrease in cognitive function was detected between cases treated with LMWH and those treated with aspirin. CONCLUSION Ischemic CVS in children is multifactorial. Thrombophilia testing should be performed in any child with CVS. Early use of aspirin improves the prognosis and has less effect on cognitive function.
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Affiliation(s)
- Azza A Eltayeb
- Assistant Professor of Pediatrics, Children University Hospital, Assiut University, Assiut, Egypt
| | - Gamal A Askar
- Children University Hospital, Assiut University, Assiut, Egypt Assistant Prof of Pediatrics, Children University Hospital, Assiut University, Egypt
| | - Naglaa H Abu Faddan
- Children University Hospital, Assiut University, Assiut, Egypt Assistant Prof of Pediatrics, Children University Hospital, Assiut University, Egypt
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24
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Zhong C, Lv L, Liu C, Zhao L, Zhou M, Sun W, Xu T, Tong W. High homocysteine and blood pressure related to poor outcome of acute ischemia stroke in Chinese population. PLoS One 2014; 9:e107498. [PMID: 25265507 PMCID: PMC4180067 DOI: 10.1371/journal.pone.0107498] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/11/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population. METHODS Between June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models. RESULTS Compared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19-1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85-1.53), 1.37 (1.03-1.84) and 1.70 (1.29-2.34), respectively. CONCLUSION The present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility to poor outcome among acute ischemic stroke patients in a northern Chinese population.
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Affiliation(s)
- Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Liying Lv
- Department of Neurology, Xinganmeng People's Hospital, Xinganmeng, Inner Mongolia, China
| | - Changjiang Liu
- Department of Neurology, Fuxin Center Hospital, Fuxin, LiaoNing, China
| | - Liang Zhao
- Department of Neurology, Affiliated Hospital of Chengde Medical University, Chengde, HeBei, China
| | - Mo Zhou
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Wenjie Sun
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, China
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, New Orleans, Louisiana, United States of America
- * E-mail: (TX); (WT)
| | - Weijun Tong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
- * E-mail: (TX); (WT)
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25
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An SA, Lee HB, Kim Y, Kim J, Kim HS, Kim WC, Kim OJ, Oh SH. Plasma total homocysteine level is associated with the pulsatility index of cerebral arteries in lacunar infarction. Yonsei Med J 2013; 54:819-24. [PMID: 23709413 PMCID: PMC3663237 DOI: 10.3349/ymj.2013.54.4.819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The pulsatility index (PI), measured by transcranial Doppler (TCD), is a surrogate marker for distal vascular resistance in cerebral arteries, and elevated plasma total homocysteine (tHcyt) is regarded as a cause of ischemic stroke, including lacunar infarction. We investigated the relationship between the PI of cerebral arteries and plasma tHcyt in patients with lacunar infarction. MATERIALS AND METHODS Plasma tHcyt level and TCD examination were performed in 94 patients with lacunar infarction. Mean flow velocity (MFV) and PI were assessed at the ipsilateral middle cerebral artery (MCA) and contralateral MCA, relative to the infarction, and the basilar artery (BA). Multivariate regression analysis was conducted between log-transformed tHcyt levels (logHcyt) and the PI of individual arteries. RESULTS There was a significant correlation between logHcyt and the PI in all tested arteries (ipsilateral MCA: r=0.21, p=0.03; contralateral MCA: r=0.21, p=0.04; BA: r=0.35, p=0.01). In multivariate regression analysis, this significance remained unchanged after adjusting for vascular risk factors, creatinine, hematocrit and platelet count (ipsilateral MCA: β=0.26, p=0.01; contralateral MCA: β=0.21, p=0.04; BA: β=0.39, p=0.001). There was no significant association between logHcyt and MFV of individual arteries. CONCLUSION A significant association between plasma tHcyt and the PI of cerebral arteries indicates that homocysteine plays a role in the increase of distal arterial resistance in lacunar infarction.
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Affiliation(s)
- Se-A An
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Han-Bin Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yoon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyun-Sook Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won-Chan Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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26
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Wu XQ, Ding J, Ge AY, Liu FF, Wang X, Fan W. Acute phase homocysteine related to severity and outcome of atherothrombotic stroke. Eur J Intern Med 2013; 24:362-7. [PMID: 23391475 DOI: 10.1016/j.ejim.2013.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/08/2013] [Accepted: 01/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Homocysteine (HCY) is associated with risk of stroke, but whether HCY affects stroke severity and prognosis remains controversial. We hypothesized HCY has an impact on atherothrombosis and this prospective study was aimed to explore the association between acute phase HCY with stroke severity and outcome in patients with atherothrombosis. METHODS Patients <72 h after symptom onset were categorized by the modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and those typed as atherothrombosis were included. Neurologic function was assessed with National Institute of Health Stroke Score (NIHSS) <72 h after symptom onset and Modified Rankin Scale (mRS) and Barthel Index (BI) 6-month, 12-month and 18-month poststroke respectively. HCY was recorded <72 h after symptom onset. Participants were divided into hHCY (HCY>15 μmol/l) and nhHCY (HCY≤15 μmol/l). The correlation between HCY and mRS was analyzed. RESULTS 125 of 130 participants without HCY interventional therapy completed the 18-month follow-up. There was no difference in demographics, histories of hypertension, diabetes mellitus, coronary heart disease, previous cerebral vascular event, and plasma low-density lipoprotein between hHCY and nhHCY. NIHSS, mRS were significantly higher and BI was significantly lower in hHCY than in nhHCY. The 18-month recurrence rate in hHCY (21.0%) was significantly higher than that in nhHCY (6.8%). Spearman correlation analysis revealed correlation between HCY and mRS (p=0.000). By ordinal logistic regression, HCY was an independent predictor of 18-month mRS (odds ratio 1.08, 95% confidence interval 1.04-1.13, p=0.000). CONCLUSIONS Acute phase elevated HCY correlated with severity and prognosis in patients with atherothrombotic stroke.
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Affiliation(s)
- Xu-Qing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
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27
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Feng C, Bai X, Xu Y, Hua T, Huang J, Liu XY. Hyperhomocysteinemia associates with small vessel disease more closely than large vessel disease. Int J Med Sci 2013; 10:408-12. [PMID: 23471237 PMCID: PMC3590600 DOI: 10.7150/ijms.5272] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 02/14/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Hyperhomocysteinemia was believed to be an independent risk factor for stroke and associate with small vessel disease (SVD) related stroke and large vessel disease (LVD) related stroke differently. However it's still unclear which type of stroke associated with homocysteine (HCY) more strongly because the conclusions of previous studies were contradictory. In this study we focused on the subclinical angiopathies of stroke, i.e., SVD and LVD instead of stroke subtypes and sought to compare the associations between HCY level and different angiopathies. METHODS 324 non-stroke patients were enrolled. Sex, age, HCY level and other vascular risk factors were collected. MRI and angiographies were used to determine the type of angiopathies and their severity, i.e., the scores of leukoaraiosis (LA), plaques and numbers of silent brain infarctions (SBI). LVD was defined as the presence of atherosclerotic plaques of cerebral arteries. SVD was defined as the presence of either LA or SBI. 230 patients were deemed to have LVD; 180 patients were deemed to have SVD. Spearman's correlation test and logistic regression were used to analyze the association between HCY level and different angiopathies. RESULTS The correlation between HCY level and scores of plaques was weaker than that of the scores of LA and numbers of SBI. Hyperhomocysteinemia was an independent risk factor for SVD (OR = 1.315, P <0.001), whereas the association between HCY level and LVD was not that significant (OR = 1.058, P = 0.075). CONCLUSION HCY level associated with SVD more strongly than LVD.
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Affiliation(s)
- Chao Feng
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, China
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28
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Park SY, An SA, Lee HB, Kim Y, Kim NK, Kim SH, Kim OJ, Oh SH. Different impact of hyperhomocysteinemia on cerebral small vessel ischemia and cervico-cerebral atherosclerosis in non-stroke individuals. Thromb Res 2012; 131:e12-6. [PMID: 23218488 DOI: 10.1016/j.thromres.2012.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 10/22/2012] [Accepted: 11/11/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to investigate the impact of plasma total homocysteine (tHcyt) levels on cervico-cerebral atherosclerosis and cerebral small vessel ischemia in non-stroke individuals. METHODS Demographic, laboratory, brain magnetic resonance imaging and magnetic resonance angiographic data were retrospectively analyzed in 682 non-stroke individuals. The association between plasma tHcyt and radiological indices of cervico-cerebral atherosclerosis (any presence of cervico-cerebral [aCC] atherosclerosis, extracranial [EC] atherosclerosis and intracranial [IC] atherosclerosis) and cerebral small vessel ischemia (silent brain infarct [SBI] and cerebral white matter hyperintensity [cWMH]) was analyzed after adjusting for cardiovascular risk factors. RESULTS There was no association between values for natural log-transformed tHcyt (log-Hcyt) and aCC atherosclerosis, EC atherosclerosis, or IC atherosclerosis. The log-Hcyt was independently associated with cWMH (OR: 3.07, 95% CI: 1.64-5.75) and SBI (OR: 2.91, 95% CI: 1.57-5.40) in multivariate analysis. Median plasma tHcyt level increased as the severity of cWMH increased. CONCLUSIONS Our results suggest that hyperhomocysteinemia plays a major role in the development of cerebral small vessel ischemia, but not in the development of atherosclerosis of major cerebral arteries.
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Affiliation(s)
- So-Young Park
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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29
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Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011; 2011:617927. [PMID: 21876810 PMCID: PMC3163144 DOI: 10.4061/2011/617927] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
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Affiliation(s)
- Yun Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shatin 999077, Hong Kong
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30
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Ma Y, Zhao X, Zhang W, Liu L, Wang Y, Fang R, Wang Y. Homocysteine and ischemic stroke subtype: a relationship study in Chinese patients. Neurol Res 2009; 32:636-41. [PMID: 19660240 DOI: 10.1179/016164109x12445616596445] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Elevated homocysteine level is a risk factor for ischemic stroke and associated with small vessel disease such as confluent leukoaraiosis in white and black population. We investigated the relationship between the total serum homocysteine level and ischemic stroke subtypes in Chinese population. METHODS Three hundred and seventy-seven acute ischemic stroke and 106 transient ischemic attack patients were consecutively enrolled into this study. Demographic information and traditional risk factors were collected. Stroke subtypes were classified using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Leukoaraiosis was graded from 0 to 3 according to the severity. Small vessel disease patients were further categorized into two subgroups of having or without confluent leukoaraiosis. RESULTS The highest homocysteine level was found in small vessel disease patients after adjusting for age, gender, traditional vascular risk factors and renal function. Homocysteine level was significantly different between the ischemic stroke and transient ischemic attack groups. Elevated homocysteine level was significantly correlated with the severity of leukoaraiosis in all patients with stroke and small vessel disease. Small vessel disease patients with leukoaraiosis had significant higher homocysteine levels than those without leukoaraiosis. CONCLUSIONS In this group of Chinese patients studied, small vessel disease patients with confluent leukoaraiosis had the highest homocysteine levels.
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Affiliation(s)
- Yuetao Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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31
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Kalita J, Kumar G, Bansal V, Misra UK. Relationship of homocysteine with other risk factors and outcome of ischemic stroke. Clin Neurol Neurosurg 2009; 111:364-7. [PMID: 19185985 DOI: 10.1016/j.clineuro.2008.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 11/14/2008] [Accepted: 12/24/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Hyperhomocysteinemia (HH) is an emerging risk factor for ischemic stroke but its role in outcome is controversial. We compare the risk factors, nature of stroke and outcome of patients with and without hyperhomocysteinemia. PATIENTS AND METHODS CT proven ischemic stroke patients were included. The conventional risk factors such as diabetes, hypertension, hyperlipidemia, obesity, smoking, and family history of stroke were recorded. Dietary history was noted. Fasting serum homocysteine (Hcy), B12 and folic acid were estimated after 1 month of stroke. Severity of stroke was assessed by Canadian Neurological Scale (CNS) and outcome at 3 months by Barthel Index (BI) score into good (BI > or = 12) and poor (BI < 12). Serum Hcy, B12 and folic acid were also estimated in 200 normal healthy volunteers. RESULTS There were 198 patients with ischemic stroke whose median age was 56 years and 36 were females. In the study group, 41.4% patients were vegetarian, 55.1% hypertensive, 24.7% diabetic, 30.8% smoker, 61.1% sedentary and 28.8% obese. 23.2% had past history of stroke and 21.7% had stroke in their first degree relative. Serum cholesterol was elevated in 11.7% and LDL in 10.8% patients. Serum Hcy was elevated in 60.6% and serum B12 low in 25.7% and folic acid in 42.1%. Hcy levels correlated with serum B12 and LDL. Patients with hyperhomocysteinemia had significantly better outcome at 3 months. Hcy levels in stroke patients did not significantly differ from controls. CONCLUSION Hyperhomocysteinemia is found in 60.6% stroke patients, which is related to low serum B12 level. Patients with hyperhomocysteinemia had a better 3-month outcome.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India
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32
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Are plasma homocysteine levels related to neurological severity and functional outcome after ischemic stroke in the Korean population? J Neurol Sci 2008; 278:60-3. [PMID: 19062047 DOI: 10.1016/j.jns.2008.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 11/17/2008] [Indexed: 11/23/2022]
Abstract
Hyperhomocysteinemia is known to be an independent risk factor for arteriosclerosis. However, the prognosis of functional disability in cerebrovascular disease has not been well established. Therefore, we conducted this study to determine the prognostic significance of plasma homocysteine (Hcy) levels in Asian patients with functional disabilities after acute ischemic stroke. A total of 267 patients were examined within 24 h after symptom onset. Hcy was measured at admission. The correlations between plasma Hcy concentration and functional disability at 1-month, 3-months, 6-months, and 12-months after stroke onset were analyzed. In addition, the associations between each risk factor for stroke or neurological severity and plasma Hcy level were evaluated. The results of the present study showed that there was no significant correlation between Hcy level on admission and modified Rankin Scale score obtained at 1-month, 3-months, 6-months, and 12-months after stroke onset. There was also no association between plasma Hcy level and neurological severity after stroke or stroke subtype. This study showed that there is no association between Hcy levels and functional outcome after stroke. Therefore, we cautiously assert that plasma Hcy levels have no value as predictors of functional disability in Asian patients with stroke.
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Khan U, Crossley C, Kalra L, Rudd A, Wolfe CDA, Collinson P, Markus HS. Homocysteine and its relationship to stroke subtypes in a UK black population: the south London ethnicity and stroke study. Stroke 2008; 39:2943-9. [PMID: 18757289 DOI: 10.1161/strokeaha.107.513416] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Homocysteine is an endothelial toxin and elevated levels have been associated with stroke risk. Stroke, particularly the small vessel disease (SVD) subtype, is increased in U.S. and UK black populations. In white populations elevated homocysteine has been associated with SVD, especially confluent leukoaraiosis, and may be acting through endothelial dysfunction. We determined the association between homocysteine and stroke subtypes, especially SVD, in a well-phenotyped UK cohort of black stroke patients compared to community controls. METHODS Homocysteine, vitamin B12, folate levels, and renal function were measured in 457 black stroke patients recruited consecutively through the prospective South London Ethnicity and Stroke Study and 179 black community controls. All patients were subtyped using modified TOAST criteria. Leukoaraiosis in SVD patients was graded according to severity, and patients were additionally categorized on the basis of presence or absence of confluent leukoaraiosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS The highest homocysteine levels were seen in SVD patients compared to controls (16.2 [11.6] versus 11.8 [5.7] mumol/L, P<0.001) after adjusting for age, gender, vascular risk factors, vitamin levels, and renal function. Within SVD cases, highest homocysteine levels were found in lacunar infarction with confluent leukoaraiosis (19.6 [14.9] mumol/L) compared to lacunar infarction without leukoaraiosis (13.6 [7.1] mumol/L, P=0.001) and controls (P<0.001). Homocysteine correlated with leukoaraiosis severity (r=0.225, P<0.001). CONCLUSIONS In this well characterized UK black stroke population homocysteine levels were elevated and highest levels were found in lacunar stroke with leukoaraiosis.
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Affiliation(s)
- Usman Khan
- Centre for Clinical Neuroscience, St. George's University of London, London, UK
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Okubadejo NU, Oladipo OO, Adeyomoye AA, Awosanya GO, Danesi MA. Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians. BMC Neurol 2008; 8:26. [PMID: 18620594 PMCID: PMC2478669 DOI: 10.1186/1471-2377-8-26] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 07/12/2008] [Indexed: 11/25/2022] Open
Abstract
Background Hyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke. Methods The study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS) scores on admission) were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization). Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS). Results We evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls). The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75). The mean duration of stroke (SD) prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88). Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men), was present in 7 (10.1%) stroke cases and 11 (12.8%) controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05). In multiple regression analysis admission NIHSS score (but not plasma Hcy) was a significant determinant of 4 week outcome measured by GOS score (P < 0.0001). Conclusion This exploratory study found that homocysteine levels are not significantly elevated in Nigerians with acute ischaemic stroke, and admission Hcy level is not a determinant of short-term (4 week) stroke outcome.
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Affiliation(s)
- Njideka U Okubadejo
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
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Kim OJ, Hong SP, Ahn JY, Hong SH, Hwang TS, Kim SO, Yoo W, Oh D, Kim NK. Influence of combined methionine synthase (MTR 2756A > G) and methylenetetrahydrofolate reductase (MTHFR 677C > T) polymorphisms to plasma homocysteine levels in Korean patients with ischemic stroke. Yonsei Med J 2007; 48:201-9. [PMID: 17461517 PMCID: PMC2628129 DOI: 10.3349/ymj.2007.48.2.201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Methionine synthase (MTR) and 5,10-methylenetetrahydrofolate reductase (MTHFR) are the main regulatory enzymes for homocysteine metabolism. The present case- control study was conducted to determine whether there is an association between the MTR 2756A > G or MTHFR 677C > T polymorphism and plasma homocysteine concentration in Korean subjects with ischemic stroke. MATERIALS AND METHODS DNA samples of 237 patients who had an ischemic stroke and 223 age and sex-matched controls were studied. MTR 2756A > G and MTHFR 677C > T genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS Frequencies of mutant alleles for MTR and MTHFR polymorphisms were not significantly different between the controls and cases. The patient group, however, had significantly higher homocysteine concentrations of the MTR 2756AA and MTHFR 677TT genotypes than the control group (p=0.04 for MTR, p=0.01 for MTHFR). The combined MTR 2756AA and MTHFR 677TT genotype (p= 0.04) and the homocysteine concentrations of the patient group were also higher than those of the controls. In addition, the genotype distribution was significant in the MTHFR 677TT genotype (p=0.008) and combined MTR 2756AA and MTHFR 677TT genotype (p=0.03), which divided the groups into the top 20% and bottom 20% based on their homocysteine levels. CONCLUSION The results of the present study demonstrate that the MTR 2756A > G and MTHFR 677C > T polymorphisms interact with elevated total homocysteine (tHcy) levels, leading to an increased risk of ischemic stroke.
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Affiliation(s)
- Ok Joon Kim
- Institute for Clinical Research, College of Medicine, Pochon CHA University, Seongnam, Korea
- Department of Neurology, College of Medicine, Pochon CHA University, Seongnam, Korea
| | | | - Jung Yong Ahn
- Department of Neurosurgery, Cerebrovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Hong
- Department of Science Education, JeJu National University of Education, JeJu, Korea
| | - Tae Sun Hwang
- Department of Anatomy, College of Medicine, Pochon CHA University, Seongnam, Korea
| | | | | | - Doyeun Oh
- Institute for Clinical Research, College of Medicine, Pochon CHA University, Seongnam, Korea
- Department of Internal Medicine, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Nam Keun Kim
- Institute for Clinical Research, College of Medicine, Pochon CHA University, Seongnam, Korea
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Abstract
Elevated homocysteine levels are associated with a variety of vascular diseases. Specifically, hyperhomocysteinemia is a risk factor for coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Laboratory-based strategies for its detection and quantification have evolved to meet the increasing need for accuracy in risk prediction. Although new technologies have been developed over the past 2 decades that have enhanced the precision of measurement, universal guidelines for circulating homocysteine determination remain lacking.
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Affiliation(s)
- Bradley A Maron
- Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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