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Shi J, Zhao Y, Chen Q, Liao X, Chen J, Xie H, Liu J, Sun J, Chen S. Association Analysis of Gut Microbiota and Prognosis of Patients with Acute Ischemic Stroke in Basal Ganglia Region. Microorganisms 2023; 11:2667. [PMID: 38004679 PMCID: PMC10673176 DOI: 10.3390/microorganisms11112667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Previous studies have implied the potential impact of gut microbiota on acute ischemic stroke (AIS), but the relationships of gut microbiota with basal ganglia region infarction (BGRI) and the predictive power of gut microbiota in BGRI prognosis is unclear. The aim of this study was to ascertain characteristic taxa of BGRI patients with different functional outcomes and identify their predictive value. Fecal samples of 65 BGRI patients were collected at admission and analyzed with 16s rRNA gene sequencing. Three-month functional outcomes of BGRI were evaluated using modified Rankin Scale (mRS), and patients with mRS score of 0-1 were assigned to good-BGRI group while others were assigned to poor-BGRI group. We further identified characteristic microbiota using linear discriminant analysis effect size, and receiver operating characteristic (ROC) curve was used to determine the predictive value of differential bacteria. According to the mRS score assessed after 3 months of stroke onset, 22 patients were assigned to poor-BGRI group, while 43 patients were assigned to good-BGRI group. Short chain fatty acids-producing bacteria, Romboutsia and Fusicatenibacter, were characteristic microbiota of the good-BGRI group, while pro-inflammatory taxa, Acetanaerobacterium, were characteristic microbiota of the poor-BGRI group. Furthermore, the differential bacteria showed extensive associations with clinical indices. ROC curves, separately plotted based on Romboutsia and Fusicatenibacter, achieved area under the curve values of 0.7193 and 0.6839, respectively. This study identified the efficient discriminative power of characteristic microbiota in BGRI patients with different outcomes and provided novel insights into the associations of gut microbiota with related risk factors.
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Affiliation(s)
- Jiayu Shi
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Yiting Zhao
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Qionglei Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Xiaolan Liao
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Jiaxin Chen
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Huijia Xie
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China;
| | - Jing Sun
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China; (J.S.); (Y.Z.); (Q.C.); (X.L.); (J.C.); (H.X.)
| | - Songfang Chen
- Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
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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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Adebayo O, Akpa O, Asowata OJ, Fakunle A, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Okekunle AP, Sunmonu T, Tiwari HK, Jenkins C, Arulogun O, Appiah L, Akinyemi J, Adeoye AM, Ogbole G, Yaria J, Arnett D, Adebayo P, Calys-Tagoe B, Ogah OS, Balogun O, Ogunjimi L, Mensah Y, Agbogu-Ike OU, Akinyemi R, Ovbiagele B, Owolabi MO. Determinants of First-Ever Stroke Severity in West Africans: Evidence From the SIREN Study. J Am Heart Assoc 2023:e027888. [PMID: 37301737 DOI: 10.1161/jaha.122.027888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/12/2023] [Indexed: 06/12/2023]
Abstract
Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43-2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93-3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03-2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93-7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5-6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1-4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2-3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3-5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0-19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.
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Affiliation(s)
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
- Institute of Cardiovascular Diseases University of Ibadan Ibadan Nigeria
| | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
| | - Adekunle Fakunle
- Department of Public Health Osun State University Osogbo Nigeria
| | - Fred S Sarfo
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Albert Akpalu
- Department of Medicine University of Ghana Medical School Accra Ghana
| | - Kolawole Wahab
- Department of Medicine University of Ilorin Teaching Hospital Ilorin Nigeria
| | - Reginald Obiako
- Department of Medicine Ahmadu Bello University Zaria Nigeria
| | - Morenikeji Komolafe
- Department of Medicine Obafemi Awolowo University Teaching Hospital Ile-Ife Nigeria
| | - Lukman Owolabi
- Department of Medicine Aminu Kano Teaching Hospital Kano Nigeria
| | | | | | - Taofiki Sunmonu
- Department of Medicine Federal Medical Centre Ondo State Owo Nigeria
| | | | | | | | - Lambert Appiah
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
| | - Abiodun M Adeoye
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Godwin Ogbole
- Department of Radiology University of Ibadan Ibadan Nigeria
| | - Joseph Yaria
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Donna Arnett
- College of Public Health University of Kentucky KY Lexington USA
| | - Philip Adebayo
- Ladoke Akintola University of Technology (LAUTECH) and LAUTECH Teaching Hospital Oyo State Ogbomoso Nigeria
- Aga-Khan University Dar es Salaam Tanzania
| | | | - Okechukwu S Ogah
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Olayemi Balogun
- Department of Medicine Ahmadu Bello University Zaria Nigeria
| | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics Olabisi Onabanjo University Abeokuta Nigeria
| | - Yaw Mensah
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | | | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine University of Ibadan Ibadan Nigeria
- Center for Genomic and Precision Medicine, College of Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine University of California San Francisco CA USA
| | - Mayowa O Owolabi
- Department of Medicine University College Hospital Ibadan Nigeria
- Center for Genomic and Precision Medicine, College of Medicine University of Ibadan Ibadan Nigeria
- Lebanese American University Beirut Lebanon
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Maksimova MY, Ivanov AV, Virus ED, Nikiforova KA, Ochtova FR, Suanova ET, Kruglova MP, Piradov MA, Kubatiev AA. Impact of glutathione on acute ischemic stroke severity and outcome: possible role of aminothiols redox status. Redox Rep 2021; 26:117-123. [PMID: 34236283 PMCID: PMC8276653 DOI: 10.1080/13510002.2021.1952819] [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] [Indexed: 12/03/2022] Open
Abstract
Objective Acute brain ischemia is accompanied by a disruption of low-molecular-weight aminothiols (LMWTs) homeostasis, such as homocysteine (Hcy), cysteine (Cys), and glutathione (GSH). We investigated the redox balance of LMWTs in blood plasma and its influence on ischemic stroke severity and the functional outcome in patients with an acute period. Patients and methods A total of 177 patients were examined. Total and reduced forms of LMWTs were determined in the first 10–24 h. Stroke severity and functional state were estimated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRs) at admission and after 21 days. Results Patients with high levels of total Hcy (> 19 μM) showed significantly reduced redox statuses of all LMWTs. Patients with low total GSH levels (≤ 1.07 μM) were at an increased risk of higher stroke severity (NIHSS > 10) compared to patients with a total GSH level > 2.64 μM (age/gender-adjusted odds ratio: 4.69, 95% CI: 1.43–15.4). Discussion (1) low total GSH level can be considered as a novel risk marker for the severity of acute stroke in conditions of low redox status of LMWTs and (2) high Hcy levels associated with low redox status of LMWTs.
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Affiliation(s)
| | - Alexander Vladimirovich Ivanov
- Department of Molecular and Cellular Pathophysiology, Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Edward Danielevich Virus
- Department of Molecular and Cellular Pathophysiology, Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Ksenya Alexandrovna Nikiforova
- Department of Molecular and Cellular Pathophysiology, Institute of General Pathology and Pathophysiology, Moscow, Russia
| | | | | | - Maria Petrovna Kruglova
- Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Aslan Amirkhanovich Kubatiev
- Department of Molecular and Cellular Pathophysiology, Institute of General Pathology and Pathophysiology, Moscow, Russia.,Russian Medical Academy of Postdoctoral Education, Moscow, Russia
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Lv P, Zheng Y, Huang J, Ke J, Zhang H. Association of Apolipoprotein E Gene Polymorphism with Ischemic Stroke in Coronary Heart Disease Patients Treated with Medium-intensity Statins. Neuropsychiatr Dis Treat 2020; 16:2459-2466. [PMID: 33122909 PMCID: PMC7591236 DOI: 10.2147/ndt.s265194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To study the association of apolipoprotein E(APOE) gene polymorphism with ischemic stroke (IS) in coronary heart disease (CHD) patients treated with medium-intensity statins. METHODS The retrospective study was performed on 662 samples including 169 CHD subjects complicated with IS, 296 subjects with CHD, and 197 control subjects. The APOE gene was obtained from case files. Univariable and multivariable logistic regression analyses were utilized to recognize the possible risks of CHD and IS. RESULTS The frequency of ε3-ε4 genotype was increased in the CHD group (p=0.013) and CHD-IS group (p=0.001), the frequency of ε4 allele was also increased in the CHD group (p=0.047) and the CHD-IS group (p=0.009) compared with control group. ε3-ε4 genotype was the independent risk for CHD and CHD-IS after adjusting for traditional risk factors with adjusted odds ratio (AOR) 2.210, 95%CI: 1.263-3.867, p=0.005) and (AOR 2.794, 95%CI: 1.539-5.072, p=0.002). The ε4 allele was also significantly associated with CHD (AOR 2.126, 95%CI: 1.265-3.575,=0.004) and CHD-IS (AOR 2.740, 95%CI: 1.569-4.784, p=0.001). CONCLUSION These results demonstrated that ε4 allele influenced the development of CHD with or without IS, especially for the genotype of ε3-ε4. CHD patients carrying the ε3-ε4 genotype and the ε4 allele were significantly associated with the incidence of IS, even if medium-intensity statins had been used.
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Affiliation(s)
- Ping Lv
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Yaofu Zheng
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Jun Huang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Junsong Ke
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Hongyu Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
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Nevmerzhytska NM, Orzheshkovskyi VV, Dzevulska IV, Savosko SI. Mechanisms of Toxic Effects of Homocysteine on the Nervous System. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09832-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Jadavji NM, Mosnier H, Kelly E, Lawrence K, Cruickshank S, Stacey S, McCall A, Dhatt S, Arning E, Bottiglieri T, Smith PD. One-carbon metabolism supplementation improves outcome after stroke in aged male MTHFR-deficient mice. Neurobiol Dis 2019; 132:104613. [DOI: 10.1016/j.nbd.2019.104613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/01/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022] Open
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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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Anniwaer J, Liu MZ, Xue KD, Maimaiti A, Xiamixiding A. Homocysteine might increase the risk of recurrence in patients presenting with primary cerebral infarction. Int J Neurosci 2019; 129:654-659. [PMID: 30215548 DOI: 10.1080/00207454.2018.1517762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Although hyperhomocysteinemia (Hhcy) is a risk factor for cerebral infarction, its effect on recurrent cerebral infarction is less-defined. We aimed to investigate the association of Hhcy and increased risk of recurrent cerebral infarct. MATERIALS AND METHODS From 2011 to 2013, we recruited 231 primary cerebral infarct patients that were divided to a Hhcy group (n = 105) and a control group (n = 126) according to plasma homocysteinemia (Hcy) levels exceeding 15 μmol/L. In this prospective study, risk factors such as gender, age, blood lipid and glucose levels, history of diabetes, high blood pressure, smoking habits and plasma Hhcy levels were determined. A three-year follow-up compared differences in cerebral infarction recurrence rates. Statistical analyses identified whether plasma Hhcy levels were an independent risk factor for recurrent cerebral infarction. RESULTS Triglyceride and low-density lipoprotein (LDL) levels in the Hhcy group were significantly higher than controls, and cerebral infarct recurrence rates in the Hhcy group exceeded control subject rates through the three-year follow-up (p = .021, p = .036 and p = .025). Cox proportional hazards modeling showed that elevated Hhcy levels (hazard ratio [HR] = 3.062, p < .001), increased age (HR = 1.069, p < .01), circulating triglyceride levels (HR = 1.686, p = .048), and relative National Institutes of Health Stroke (NIHSS) score (HR = 1.068, p = .016) were risk factors for recurrent cerebral infarction. CONCLUSIONS Level of Hhcy was a risk factor for recurrent cerebral infarction. Further, particular demographic and clinical outcomes including age, relative NIHSS scores, and circulating triglyceride levels were markedly associated with the occurrence of cerebral infarction.
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Affiliation(s)
- Jianati Anniwaer
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Meng-Zhuang Liu
- b Department of General Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Ke-Dong Xue
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Abuduzhayier Maimaiti
- b Department of General Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Aersilan Xiamixiding
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
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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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Xie JC, Lin YY, Liu XH, Zhao YC, Ma XY, Yu J, Liu XY, Zhao YX. Homocysteine is Associated with Exaggerated Morning Blood Pressure Surge in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:2650-2656. [PMID: 29960667 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Considerable researches suggest that high level of homocysteine (Hcy) is associated with the risk of ischemic stroke. Ambulatory blood pressure monitoring (ABPM) parameters have also been confirmed associated with cardio-cerebrovascular events. However, the relationship between Hcy and ABPM parameters remains unclear in patients with acute ischemic stroke. In this study, we aim to investigate the association between Hcy level and ABPM parameters in patients with acute ischemic stroke. METHODS We enrolled 60 patients with acute ischemic stroke who received ABPM. We calculated ABPM parameters like morning blood pressure surge (MBPS), ambulatory arterial stiffness index, blood pressure variability, and night dipping patterns. RESULTS Multivariate logistic regression analysis indicated that patients in the top quartile of Hcy level tended to have a higher level of prewaking and sleep-trough MBPS compared with patients in the lower 3 quartiles after adjusted for age and gender (P = .028 and P = .030, respectively). When treating Hcy as a continuous variable, the linear regression showed the association between Hcy level and both MBPS parameters remained significant (prewaking MBPS, r = .356, P = .022; sleep-trough MBPS, r = .365, P = .017, respectively). However, there is no association between Hcy level and ambulatory arterial stiffness index, blood pressure variability or night dipping patterns (P = .635, P = .348 and P = .127 respectively). CONCLUSIONS There is a relationship between the 2 major cerebrovascular risk factors: MBPS and Hcy.
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Affiliation(s)
- Jun-Chao Xie
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ying-Ying Lin
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao-Hui Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yi-Chen Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao-Ye Ma
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jia Yu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xue-Yuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
| | - Yan-Xin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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12
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Fan YL, Zhan R, Dong YF, Huang L, Ji XX, Lu P, Liu J, Li P, Cheng XS. Significant interaction of hypertension and homocysteine on neurological severity in first-ever ischemic stroke patients. ACTA ACUST UNITED AC 2018; 12:534-541. [PMID: 29678422 DOI: 10.1016/j.jash.2018.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
It is not known whether combination of hypertension and high homocysteine (HHcy) impacts on stroke-related neurological severity. Our aim was to determine whether there is an interaction of hypertension and HHcy on neurological severity in first-ever ischemic stroke patients. We analyzed neurological severity among 189 consecutive first-ever ischemic stroke patients with or without hypertension or HHcy. Hypertension (odds ratio [OR]: 8.086, 95% confidence interval [CI]: 3.596-18.181, P < .001) and total homocysteine (OR: 1.403, 95% CI: 1.247-1.579, P < .001) were independently associated with neurological severity. In receiver-operating characteristic analysis, total homocysteine was a significant predictor of neurological severity (area under curve: 0.794; P < .001). A multiplicative interaction of hypertension and HHcy on more severe neurological severity was revealed by binary logistic regression (OR: 13.154, 95% CI: 5.293-32.691, P < .001). Analysis further identified a more than multiplicative interaction of hypertension and HHcy on neurological severity compared with patients without each condition (OR: 50.600, 95% CI: 14.775-173.285, P < .001). Interaction effect measured on an additive scale showed that 76.4% patients with moderate/severe neurological severity were attributed to interaction of hypertension and HHcy. Significant interaction of hypertension and HHcy on neurological severity was found on multiplicative and additive scale in first-ever Chinese ischemic stroke patients.
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Affiliation(s)
- Ying-Li Fan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Rui Zhan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yi-Fei Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang, Jiangxi, China.
| | - Lei Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xi-Xin Ji
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Peng Lu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jian Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao-Shu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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13
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Huo Y, Wu X, Ding J, Geng Y, Qiao W, Ge A, Guo C, Lv J, Bao H, Fan W. Vascular Remodeling, Oxidative Stress, and Disrupted PPAR γ Expression in Rats of Long-Term Hyperhomocysteinemia with Metabolic Disturbance. PPAR Res 2018; 2018:6738703. [PMID: 29552030 PMCID: PMC5820553 DOI: 10.1155/2018/6738703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
Abstract
Hyperhomocysteinemia, a risk factor for vascular disease, is associated with metabolic syndrome. Our study was aimed at exploring the effect of long-term hyperhomocysteinemia with metabolic disturbances on vascular remodeling. We also studied oxidative stress and expression of PPARγ in the coronary arteriole as a possible mechanism underlying vascular remodeling. Rats were treated with standard rodent chow (Control) or diet enriched in methionine (Met) for 48 weeks. Plasma homocysteine, blood glucose, serum lipids, malondialdehyde (MDA), superoxide dismutase (SOD), and nitric oxide (NO) levels were measured. Coronary arteriolar and carotid arterial remodeling was assessed by histomorphometric techniques and the expression of PPARγ in vessel wall was investigated. In Met group, an increase in the level of fasting blood glucose, serum triglyceride, total cholesterol, MDA, and NO, a decline in the serum SOD level, and increased collagen deposition in coronary and carotid arteries were found. Moreover, we detected decreased expression of PPARγ in the coronary arterioles in Met group. In summary, our study revealed metabolic disturbances in this model of long-term hyperhomocysteinemia together with vascular remodeling and suggested that impaired oxidative stress, endothelium dysfunction, and decreased PPARγ expression in the vessel wall could be underlying mechanisms.
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Affiliation(s)
- Yajing Huo
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xuqing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yang Geng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weiwei Qiao
- Department of Laboratory Animal Science, Fudan University, Shanghai 200032, China
| | - Anyan Ge
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cen Guo
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianing Lv
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Haifeng Bao
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Fan
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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14
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Effect of Hyperhomocysteinemia on Redox Balance and Redox Defence Enzymes in Ischemia-Reperfusion Injury and/or After Ischemic Preconditioning in Rats. Cell Mol Neurobiol 2017; 37:1417-1431. [PMID: 28210876 DOI: 10.1007/s10571-017-0473-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/12/2017] [Indexed: 12/21/2022]
Abstract
Increased level of homocysteine (hHcy) in plasma is an accompanying phenomenon of many diseases, including a brain stroke. This study determines whether hyperhomocysteinemia (which is a risk factor of brain ischemia) itself or in combination with ischemic preconditioning affects the ischemia-induced neurodegenerative changes, generation of reactive oxygen species (ROS), lipoperoxidation, protein oxidation, and activity of antioxidant enzymes in the rat brain cortex. The hHcy was induced by subcutaneous administration of homocysteine (0.45 μmol/g body weight) twice a day in 8 h intervals for 14 days. Rats were preconditioned by 5 min ischemia. Two days later, 15 min of global forebrain ischemia was induced by four vessel's occlusion. The study demonstrates that in the cerebral cortex, hHcy alone induces progressive neuronal cell death and morphological changes. Neuronal damage was associated with the pro-oxidative effect of hHcy, which leads to increased ROS formation, peroxidation of lipids and oxidative alterations of cortical proteins. Ischemic reperfusion injury activates degeneration processes and de-regulates redox balance which is aggravated under hHcy conditions and leads to the augmented lipoperoxidation and protein oxidation. If combined with hHcy, ischemic preconditioning could preserve the neuronal tissue from lethal ischemic effect and initiates suppression of lipoperoxidation, protein oxidation, and alterations of redox enzymes with the most significant effect observed after prolonged reperfusion. Increased prevalence of hyperhomocysteinemia in the Western population and crucial role of elevated Hcy level in the pathogenesis of neuronal disorders makes this amino acid as an interesting target for future research. Understanding the multiple etiological mechanisms and recognition of the co-morbid risk factors that lead to the ischemic/reperfusion injury and ischemic tolerance is therefore important for developing therapeutic strategies in human brain stroke associated with the elevated level of Hcy.
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15
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Ye Z, Zhang Z, Zhang H, Hao Y, Zhang J, Liu W, Xu G, Liu X. Prognostic Value of C-Reactive Protein and Homocysteine in Large-Artery Atherosclerotic Stroke: a Prospective Observational Study. J Stroke Cerebrovasc Dis 2016; 26:618-626. [PMID: 27979431 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/06/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Our objective is to investigate whether C-reactive protein (CRP) and homocysteine (Hcy) levels in the acute phase of large-artery atherosclerotic stroke predict long-term functional disability and recurrent vascular events. METHODS Patients with first-ever large-artery atherosclerotic ischemic stroke were prospectively registered in the Nanjing Stroke Registry Program between January 2012 and June 2014. Venous blood samples were collected within 2 weeks after the index stroke. Patients were followed up for 1 year. The Kaplan-Meier method was performed in survival analysis. Multiple logistic regression analysis and Cox proportional hazard model were applied to identify predictors of functional disability and recurrent vascular events, respectively. RESULTS A total of 625 eligible patients (458 males) were evaluated. During the 1-year follow-up period, 63 patients suffered recurrent vascular events. An elevated CRP level is an independent predictor of poor functional disability at 1 year (P for trend = .002), in both males (P for trend = .017) and females (P for trend = .042). Hcy showed no relationship with functional disability. No significant relationship between CRP and Hcy levels and recurrent vascular events was found in total patients in multiple models. Stratified by sex, high Hcy levels were associated with recurrent vascular events in females (P for trend = .036) but not in males. CONCLUSIONS Elevated CRP levels are associated with poor functional disability in patients with large-artery atherosclerotic stroke at 1 year, and Hcy is a relatively moderate predictor of recurrent vascular events in female patients with large-artery atherosclerotic stroke at 1 year.
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Affiliation(s)
- Zusen Ye
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China; Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhizhong Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Neurology, The First People's Hospital of Hangzhou, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Yonggang Hao
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China
| | - Jun Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Wenhua Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
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16
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Jia J, Wang A, Wang J, Wu J, Yan X, Zhou Y, Chen S, Zhao X. Homocysteine and Its Relationship to Asymptomatic Carotid Stenosis in a Chinese Community Population. Sci Rep 2016; 6:37361. [PMID: 27869211 PMCID: PMC5116757 DOI: 10.1038/srep37361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022] Open
Abstract
Little is known about the association between homocysteine (Hcy) and asymptomatic CAS in the healthy population. The purpose of this study was to investigate the relationship between Hcy levels and asymptomatic CAS in a Chinese community population. The current study included 5393 participants who were age of 40 years or older, and free of stroke, transient ischemic attack, and coronary artery disease. Demographic and clinical variables were investigated, and the presence of CAS was assessed by Color Doppler Ultrasound. A multivariate logistic regression was used to examine the association between Hcy levels and asymptomatic CAS. 361 (6.69%) participants were diagnosed with asymptomatic CAS, who had higher Hcy levels compared with those without (p-value for trend = 0.0001). After adjusting other possible risk factors, Hcy > 19.3μmol/L was considered as an independent indicator of asymptomatic CAS (OR 1.53, 95%CI 1.05–2.23; p-value for trend = 0.0265), but with a difference between participants with diabetes and without [OR (95%CI): 2.89(1.02–8.22) vs. 1.42(0.95–2.12); P interaction < 0.05]. In this large-population, community-based study, Hcy is an independent indicator of asymptomatic CAS, especially in patients with diabetes.
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Affiliation(s)
- Jiaokun Jia
- Department of Neurology, 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 Disease, Beijing, China
| | - Anxin Wang
- Department of Neurology, 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 Disease, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, 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 Disease, Beijing, China
| | - Jianwei Wu
- Department of Neurology, 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 Disease, Beijing, China
| | - Xiujuan Yan
- Department of Neurology, 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 Disease, Beijing, China
| | - Yong Zhou
- Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shengyun Chen
- Department of Neurology, 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 Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, 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 Disease, Beijing, China
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17
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De Giuseppe R, Venturelli G, Guez S, Salera S, De Vita C, Consonni D, Dellanoce C, Bamonti F, Chiarelli G, Manzoni F, Maiavacca R, Esposito S. Homocysteine metabolism in children and adolescents with epidermolysis bullosa. BMC Pediatr 2016; 16:173. [PMID: 27793182 PMCID: PMC5086034 DOI: 10.1186/s12887-016-0714-7] [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: 01/22/2016] [Accepted: 10/21/2016] [Indexed: 12/28/2022] Open
Abstract
Background Epidermolysis bullosa (EB) belongs to a family of rare heterogeneous, genetic disorders characterized by blistering of the skin and mucous membranes in response to minor mechanical trauma. The involvement of the oral mucosa and oesophagus stenosis is suggested to be responsible for severe nutritional deficiencies, but few studies have till now considered this aspect. This observational study aimed to evaluate homocysteine status in children and adolescents with EB by assessing total plasma homocysteine (tHcy) and metabolically related vitamins (B6, B12, folate) concentrations. Methods Twenty EB patients (12 M; age range 0.5−19 years) were evaluated for: plasma tHcy, serum B12 and holotranscobalamin (HoloTC, the active fraction of B12), serum and erythrocyte folate (s-F and Ery-F, respectively), plasma B6 and serum high sensitive C-reactive-protein (hsCRP) levels. Clinical severity was also evaluated through the Birmingham Epidermolysis Bullosa Severity (BEBS) score. A sex and age well-matched population was also enrolled. Results EB patients showed tHcy levels higher (p = 0.04) and B6 levels lower (p = 0.03) than controls. B12, HoloTC, s-F and ery-F concentrations did not differ between patients and controls. Multiple linear regression analysis showed that tHcy levels were independent of the metabolically related vitamins levels. In addition, serum hsCRP levels were higher in EB patients than in controls (p = 0.003) and correlated negatively with B6 concentrations (r = -0.6; p = 0.009). BEBS score correlated negatively with HoloTC (p = 0.022) and B6 (p = 0.005) levels and positively with age (p = 0.031) and hsCRP levels (p < 0.001). Conclusions The assessment of tHcy and metabolically related vitamin levels describes an important aspect of EB patients’ nutritional status which can result essential for their long term care. Monitoring B6 levels in EB patients could be particularly important in order to prevent several complications associated with B6 deficiency and to avoid a B6 excess which sustains an inflammatory condition.
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Affiliation(s)
- Rachele De Giuseppe
- Institute of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
| | - Greta Venturelli
- Internal Medicine and Metabolic Diseases; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sophie Guez
- Pediatric Highly Intensive Care Unit, University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Salera
- Pediatric Highly Intensive Care Unit, University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia De Vita
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit; Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cinzia Dellanoce
- CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Fabrizia Bamonti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gabriella Chiarelli
- Pediatric Highly Intensive Care Unit, University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Manzoni
- Pediatric Highly Intensive Care Unit, University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rita Maiavacca
- Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Kumral E, Saruhan G, Aktert D, Orman M. Association of Hyperhomocysteinemia with Stroke Recurrence after Initial Stroke. J Stroke Cerebrovasc Dis 2016; 25:2047-54. [PMID: 27260368 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Homocysteine (Hcy) is closely associated with stroke. Despite the fact that Hcy has consistently been shown to predict development of recurrent stroke, prior studies on the association of Hcy and stroke subtypes have been inconclusive. METHODS Data from the Ege Stroke Registry were examined and 5-year follow-up data were analyzed. Multivariate survival analyses were undertaken using Cox proportional hazards models to determine the prognostic value of Hcy in different ischemic stroke subtypes. RESULTS Of the 9522 patients with stroke, 307 (27%) with hyperhomocysteinemia (hHcy) had recurrent stroke. Univariate Cox regression model showed that hHcy group was associated with recurrent stroke (crude hazard ratio [HR] 1.16; 95% CI 1.02-1.30). But there was no such association in multivariate regression models (adjusted HR 1.11; 95% CI .97-1.26). hHcy was not associated with any ischemic stroke subtypes at 5 years. Univariate Cox regression model showed that hHcy group was associated with overall cardiovascular events (crude HR 1.44; 95% CI 1.32-1.57). However, this association no longer existed in multivariate regression models (adjusted HR 1.01; 95% CI .93-1.12). Higher plasma Hcy group was significantly associated with higher mortality compared with normal plasma Hcy group (OR 1.83; 95% CI .45-2.32). CONCLUSIONS Our results showed that elevated Hcy is not associated independently with stroke recurrence and overall cardiovascular events in patients with ischemic stroke. There was no association between the hHcy and stroke recurrence in the stroke subtypes within 5 years.
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Affiliation(s)
- Emre Kumral
- Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
| | - Gülsüm Saruhan
- Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey
| | - Dilara Aktert
- Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Orman
- Biostatistic Department, School of Medicine, Ege University, İzmir, Turkey
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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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Chernyavskiy I, Veeranki S, Sen U, Tyagi SC. Atherogenesis: hyperhomocysteinemia interactions with LDL, macrophage function, paraoxonase 1, and exercise. Ann N Y Acad Sci 2016; 1363:138-54. [PMID: 26849408 DOI: 10.1111/nyas.13009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022]
Abstract
Despite great strides in understanding the atherogenesis process, the mechanisms are not entirely known. In addition to diet, cigarette smoking, genetic predisposition, and hypertension, hyperhomocysteinemia (HHcy), an accumulation of the noncoding sulfur-containing amino acid homocysteine (Hcy), is a significant contributor to atherogenesis. Although exercise decreases HHcy and increases longevity, the complete mechanism is unclear. In light of recent evidence, in this review, we focus on the effects of HHcy on macrophage function, differentiation, and polarization. Though there is need for further evidence, it is most likely that HHcy-mediated alterations in macrophage function are important contributors to atherogenesis, and HHcy-countering strategies, such as nutrition and exercise, should be included in the combinatorial regimens for effective prevention and regression of atherosclerotic plaques. Therefore, we also included a discussion on the effects of exercise on the HHcy-mediated atherogenic process.
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Affiliation(s)
- Ilya Chernyavskiy
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Sudhakar Veeranki
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Utpal Sen
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Suresh C Tyagi
- Department of Physiology, University of Louisville, Louisville, Kentucky
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22
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Dhandapani S, Goudihalli S, Mukherjee KK, Singh H, Srinivasan A, Danish M, Mahalingam S, Dhandapani M, Gupta SK, Khandelwal N, Mathuriya SN. Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: a case for the reverse epidemiology paradox? Acta Neurochir (Wien) 2015; 157:399-407. [PMID: 25510646 DOI: 10.1007/s00701-014-2297-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH. METHODS Admission plasma tHcy was evaluated in 90 SAH patients and prospectively studied in relation to various factors and the Glasgow Outcome Scale (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21. RESULTS tHcy was significantly higher following SAH compared to matched controls [median (IQR): 25.7 (17.3-35.9) vs. 14.0 (9.8-17.6) μmol/l, p < 0.001]. It was significantly higher in younger patients. However, systemic disease, WFNS and Fisher grades did not have a significant impact on its levels. tHcy was significantly lower among patients who died [median (IQR): 16.0 (14.4-20.6) vs. 29.7 (21.8-40.2) μmol/l, p < 0.001] and those with unfavorable outcome (GOS 1-3) [median (IQR): 21.6 (14.5-28.2) vs. 30.3 (20.4-40.7) μmol/l, p = 0.004] compared to others, with a significant continuous positive correlation between tHcy and GOS (p = 0.002). The beneficial association of tHcy with outcome was homogeneous with no significant subgroup difference. Multivariate analysis using binary logistic regression adjusting for the effects of age, systemic disease, WFNS grade, Fisher grade, site of aneurysm, clipping or coiling revealed higher tHcy to have a significant independent association with both survival (p = 0.01) and favorable outcome (p = 0.04). CONCLUSIONS Higher homocysteine levels following SAH appear to have a significant association with both survival and favorable neurological outcome, independent of other known prognostic factors, apparently exemplifying "reverse epidemiology paradox" in which a conventional risk factor seems to impart a survival advantage.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India,
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Fu HJ, Zhao LB, Xue JJ, Wu ZX, Huang YP, Liu W, Gao Z. Elevated Serum Homocysteine (Hcy) Levels May Contribute to the Pathogenesis of Cerebral Infarction. J Mol Neurosci 2015; 56:553-61. [DOI: 10.1007/s12031-015-0497-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/14/2015] [Indexed: 11/24/2022]
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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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Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med 2014; 12:119. [PMID: 25012298 PMCID: PMC4226994 DOI: 10.1186/s12916-014-0119-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/20/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI). SBIs are a relatively new consideration as improved imaging has facilitated recognition of their occurrence. However, the true incidence, prevalence and risk factors associated with SBI remain controversial. METHODS Systematic searches of the Medline and EMBASE databases from 1946 to December 2013 were performed to identify original studies of population-based adult cohorts derived from community surveys and routine health screening that reported the incidence and prevalence of magnetic resonance imaging (MRI)-determined SBI. RESULTS The prevalence of SBI ranges from 5% to 62% with most studies reported in the 10% to 20% range. Longitudinal studies suggest an annual incidence of between 2% and 4%. A strong association was seen to exist between epidemiological estimates of SBI and age of the population assessed. Hypertension, carotid stenosis, chronic kidney disease and metabolic syndrome all showed a strong association with SBI. Heart failure, coronary artery disease, hyperhomocysteinemia and obstructive sleep apnea are also likely of significance. However, any association between SBI and gender, ethnicity, tobacco or alcohol consumption, obesity, dyslipidemia, atrial fibrillation and diabetes mellitus remains unclear. CONCLUSIONS SBI is a remarkably common phenomenon and endemic among older people. This systematic review supports the association of a number of traditional vascular risk factors, but also highlights disparities between clinically apparent and silent strokes, potentially suggesting important differences in pathophysiology and warranting further investigation.
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Wang CY, Chen ZW, Zhang T, Liu J, Chen SH, Liu SY, Han LY, Hui ZH, Chen YM. Elevated plasma homocysteine level is associated with ischemic stroke in Chinese hypertensive patients. Eur J Intern Med 2014; 25:538-44. [PMID: 24824758 DOI: 10.1016/j.ejim.2014.04.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 04/19/2014] [Accepted: 04/19/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accumulating data suggest that hyperhomocysteinemia is associated with the risk of ischemic stroke (IS) and coronary heart disease (CHD) in the general population, but the relationship remains unclear in hypertensive patients. We examined the association of total homocysteine (tHcy) with IS and CHD in hypertensive patients. METHODS A total of 5935 Chinese hypertensive patients were recruited in a community-based cross-sectional study from 60 communities in Shenzhen, China. Plasma tHcy was quantitatively measured using the enzyme cycle method. Conventional risk factors for IS and CHD were obtained through questionnaire interviews and physical examinations. We included cerebral infarction, embolism and small-vessel disease as IS; and myocardial infarction, angina pectoris, coronary revascularization, and cardiac arrest as CHD. IS and CHD were retrospectively adjudicated by specialists via interviews, hospital records or relevant tests. RESULTS Significantly higher values of tHcy were observed in IS patients than in non-IS controls among both men and women. Greater tHcy level was dose dependently associated with an increased risk of IS presence in women, men and them combined (p-trend: 0.002, 3.8×10(-4) and 0.001). The odds ratios (95% CI) of IS for tHcy ≥30 (vs. <15) μmol/L were 2.84 (1.73-4.34) in men, 4.41 (1.62-9.15) in women, and 2.86 (1.72-4.75) in their combination after adjusting for other main risk factors of IS. We did not find any significant association between tHcy and presence of CHD after the adjustment for covariates. CONCLUSIONS Plasma homocysteine level is positively associated with the presence of IS, but not CHD, in Chinese hypertensive patients.
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Affiliation(s)
- Chang-yi Wang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China; Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, People's Republic of China
| | - Zhong-wei Chen
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, People's Republic of China
| | - Tao Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, People's Republic of China
| | - Jun Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Si-han Chen
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, People's Republic of China
| | - Sheng-yuan Liu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, People's Republic of China
| | - Li-yuan Han
- Department of Preventive Medicine, Medical School of Ningbo University, Ningbo, 315211, People's Republic of China
| | - Zhao-hui Hui
- Shenzhen Xili People's Hospital, Shenzhen, 518054, People's Republic of China
| | - Yu-ming Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
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Alzoubi KH, Khabour OF, Al-Azzam SI, Tashtoush MH, Mhaidat NM. Metformin Eased Cognitive Impairment Induced by Chronic L-methionine Administration: Potential Role of Oxidative Stress. Curr Neuropharmacol 2014; 12:186-92. [PMID: 24669211 PMCID: PMC3964748 DOI: 10.2174/1570159x11666131120223201] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 06/10/2013] [Accepted: 11/02/2013] [Indexed: 11/22/2022] Open
Abstract
Chronic administration of L-methionine leads to memory impairment, which is attributed to increase in the level of oxidative stress in the brain. On the other hand, metformin is a commonly used antidiabetic drug with strong antioxidant properties. In the current study, we tested if chronic metformin administration prevents memory impairment induced by administration of L-methionine. In addition, a number of molecules related to the action of metformin on cognitive functions were examined. Both metformin and L-methionine were administered to animals by oral gavage. Testing of spatial learning and memory was carried out using radial arm water maze (RAWM). Additionally, hippocampal levels or activities of catalase, thiobarbituric acid reactive substances (TBARs), glutathione peroxidase (GPx), glutathione (GSH), oxidized glutathione (GSSG) and GSH/GSSG ratio were determined. Results showed that chronic L-methionine administration resulted in both short- and long- term memory impairment, whereas metformin treatment prevented such effect. Additionally, L-methionine treatment induced significant elevation in GSSG and TBARs, along with reduction in GSH/GSSG ratio and activities of catalase, and GPx. These effects were shown to be restored by metformin treatment. In conclusion, L-methionine induced memory impairment, and treatment with metformin prevented this impairment probably by normalizing oxidative stress in the hippocampus.
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Affiliation(s)
- Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad H Tashtoush
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nizar M Mhaidat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Miao Y, Liao JK. Potential serum biomarkers in the pathophysiological processes of stroke. Expert Rev Neurother 2014; 14:173-85. [PMID: 24417214 DOI: 10.1586/14737175.2014.875471] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is a leading cause of death and serious long-term disability. Ischemic stroke is the major subtype of stroke. Currently, its diagnosis is mainly dependent upon clinical symptoms and neuroimaging techniques. Despite these clinical and imaging modalities, often strokes are not recognized after initial onset. As early intervention of medical or surgical therapy is often associated with improved outcomes, there is an urgent need to improve the speed and accuracy of stroke diagnosis. Stroke is a complex pathophysiological process involving; energy failure, imbalance of ion homeostasis, acidosis, intracellular calcium overload, neuronal excitotoxicity, free radical-mediated lipid oxidation, inflammatory cell infiltration, and glial cell activation. These events ultimately lead to neuronal apoptotic cell death or necrosis. In this review, we have summarized the serum biomarkers according to the pathophysiological processes of stroke, which have been intensively studied in clinical trials of stroke over the past five years, and also used Medline's 'related article' option to identify further articles. We focused on the potential biomarkers pertaining to vascular injury, metabolic changes, oxidative injury, and inflammation, and newly studied biomarkers, and discussed how these biomarkers could be used for the diagnosis or determining the prognosis of stroke.
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Affiliation(s)
- Yanying Miao
- Department of Medicine, University of Chicago, Section of Cardiology, Chicago, IL 60637, USA
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29
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Wu XQ, Ding J, Ge AY, Wang X, Fan W. Acute phase homocysteine related to severity and outcome of atherothrombotic stroke - reply. Eur J Intern Med 2014; 25:e15. [PMID: 23842439 DOI: 10.1016/j.ejim.2013.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Xu-Qing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - An-Yan Ge
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China; Institute of Brain Science and State Key laboratory of Medical Neurobiology, Fudan University, 200032 Shanghai, China
| | - Wei Fan
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
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Prognostic value of inflammatory mediators in 1-year outcome of acute ischemic stroke with middle cerebral artery stenosis. Mediators Inflamm 2013; 2013:850714. [PMID: 24023414 PMCID: PMC3760102 DOI: 10.1155/2013/850714] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 12/31/2022] Open
Abstract
Background and Purpose. Inflammation exists in inception, progression, and reperfusion of acute ischemic stroke. Insightful understanding of correlation in inflammatory mediators and stroke severity with intracranial artery stenosis may improve rational stroke therapy. Methods. We prospectively recruited 977 patients with acute noncardioembolic ischemic stroke with MCA stenosis by MRA as none to mild (<50%), moderate (50–69%), severe (70–99%), or occlusive (100%). The peripheral levels of WBC, homocysteine (HCY), and high sensitivity C-reactive protein (hs-CRP) were recorded. All patients were assessed of 1-year outcome by mRS as favorable (0–2) or poor (3–6). Results. The levels of WBC, HCY, and hs-CRP had no significant differences in patients with categorized MCA stenosis (all P > 0.05). Higher levels of WBC, HCY, and hs-CRP were found in patients with 1-year poor outcome (all P < 0.05), but only hs-CRP is an independent predictor (OR 1.06, 95% CI 1.027–1.093, P = 0.0003). The combination of any two of increased hs-CRP (>3 mg/L), WBC (>6.91 × 109/L), and HCY (>15 μmol/L) had higher power in predicting 1-year poor outcome than the single elevated mediator. Conclusions. Elevated hs-CRP independently predicts 1-year poor outcome in acute stroke. The combination of increased hs-CRP, WBC, or HCY had a stronger predictive value in poor outcome than individual elevated mediator.
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