Modifiable Risk Factors Associated With Moyamoya Disease

Ge, Peicong; Zhang, Qian; Ye, Xun; Liu, Xingju; Deng, Xiaofeng; Jia, Wang; Wang, Rong; Zhang, Yan; Zhang, Dong; Zhao, Jizong

doi:10.1161/strokeaha.120.030027

Cited by 45 publications

(39 citation statements)

References 43 publications

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“…These was consistent with the proportion of comorbidities reported in other large retrospective studies in China. 26 Compared to the recent large-scale studies in Japan, the prevalence of hyperlipidemia (11%) was similar with our study, however, we reported a relatively higher prevalence of hypertension and diabetes with a proportion of 35% and 5% in Japan. 27 Moreover, several studies indicated that preoperative hypertension was an independent risk factor for postoperative ICH after revascularization, and hypertension was associated with increased mortality in natural course of hemorrhagic MMD, which suggested more attention in preoperative blood pressure management and subsequent clinical follow-up.…”

Section: Discussionsupporting

confidence: 88%

Epidemiology of Moyamoya disease in China: A nationwide hospital-based study

Dong

Huang

et al. 2022

The Lancet Regional Health - Western Pacific

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Background The national epidemiologic data in mainland China is still absent for moyamoya disease (MMD).Methods This study was a nationwide hospital-based observational retrospective study to estimate epidemiological characteristics of MMD. The data was based on the Hospital Quality Monitoring System (HQMS), a national database which covers all tertiary hospitals in mainland China. This system consistently collects medical records including demographic characteristics, diagnoses, procedures, and expenses etc. for all inpatients. MMD was identified by ICD-10 code (I67¢5) in HQMS.Findings A total of 47,443 new-onset patients with total 69,680 hospitalization records from 1312 hospitals during 2016 to 2018 were included. The annual incidence rate was 1¢14 per 100,000 inhabitants (95% CI, 1¢12−1¢16) and approximately a 2-fold increase from 2016 to 2018. The incidence in children (0¢18 per 100,000 inhabitants per year; 95% CI, 0¢17−0¢20) was significantly lower than that in adults (1¢40 per 100,000; 95% CI, 1¢38−1¢42) (P<0¢001) and the peak incidence was 45−54 years. The distribution model of incidence rate was presented as a clustered regional pattern (Moran's I = 0¢155, P = 0¢018, Z = 2¢375) by global spatial correlation analysis.Interpretation Our study reported the annual incidence of MMD was 1¢14 per 100,000 inhabitants in mainland China during 2016 to 2018, and it was increasing year by year. The geographical distribution of MMD incidence presented as a clustered regional pattern, which may provide new view for future study on the etiology for MMD.

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Section: Discussionsupporting

confidence: 88%

Epidemiology of Moyamoya disease in China: A nationwide hospital-based study

Dong

Huang

et al. 2022

The Lancet Regional Health - Western Pacific

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“…In addition to a clear direct role of RNF213 in triglyceride accumulation in lipid droplets [43], unbiased analyses revealed RNF213 as an important modulator of lipotoxicity caused by saturated fatty acids through inhibition of stearoyl-CoA desaturase (SCD-1) [16]. Ge et al reported that the HDL-cholesterol level was inversely associated with the risk of MA [59]. Moreover, dyslipidemia was shown as a risk factor for contralateral progression in patients with unilateral MA [60].…”

Section: Discussionmentioning

confidence: 99%

Plasma Lipid Profiling Contributes to Untangle the Complexity of Moyamoya Arteriopathy

Dei

Carrozzini

Pollaci

et al. 2021

IJMS

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Moyamoya arteriopathy (MA) is a rare cerebrovascular disorder characterized by ischemic/hemorrhagic strokes. The pathophysiology is unknown. A deregulation of vasculogenic/angiogenic/inflammatory pathways has been hypothesized as a possible pathophysiological mechanism. Since lipids are implicated in modulating neo-vascularization/angiogenesis and inflammation, their deregulation is potentially involved in MA. Our aim is to evaluate angiogenic/vasculogenic/inflammatory proteins and lipid profile in plasma of MA patients and control subjects (healthy donors HD or subjects with atherosclerotic cerebrovascular disease ACVD). Angiogenic and inflammatory protein levels were measured by ELISA and a complete lipidomic analysis was performed on plasma by mass spectrometry. ELISA showed a significant decrease for MMP-9 released in plasma of MA. The untargeted lipidomic analysis showed a cumulative depletion of lipid asset in plasma of MA as compared to HD. Specifically, a decrease in membrane complex glycosphingolipids peripherally circulating in MA plasma with respect to HD was observed, likely suggestive of cerebral cellular recruitment. The quantitative targeted approach demonstrated an increase in free sphingoid bases, likely associated with a deregulated angiogenesis. Our findings indicate that lipid signature could play a central role in MA and that a detailed biomarker profile may contribute to untangle the complex, and still obscure, pathogenesis of MA.

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“…We supposed that the lower serum Hcy level attributed to the activation in the cas-cade usage of Hcy's endogenously thrombotic effect after the hemorrhagic bAVM. As an intermediate metabolic product in the circle involving folate and vitamins, Hcy could be modifiable [33]. Two randomized controlled trials showed 5 Disease Markers that folic acid/vitamin B12 or vitamin B6 had no effect of treatment on total mortality [3,4].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Homocysteine Level on Neurological Outcome in Brain Arteriovenous Malformations

Lin

Zeng

et al. 2020

Disease Markers

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Objective. We aimed to investigate the serum homocysteine (Hcy) level in patients with brain arteriovenous malformation (bAVM) and their impact on neurological outcome during hospitalization. Method. We retrospectively reviewed patients diagnosed with bAVMs in Beijing Tiantan Hospital from January 2019 to August 2020. Patients were divided into two groups according to the mRS (modified Rankin Scale) score at discharge. Clinical and laboratory characteristics were compared. Logistic regression analyses were performed to identify the potential risk factors for short-term neurological outcome. Results. A total of 175 bAVM patients were enrolled in the study, including 139 patients with favorable outcome ( mRS ≤ 2 ) and 36 patients with unfavorable outcome ( mRS > 2 ). Hyperhomocysteinemia was identified in 32.6% of cases ( n = 57 ). Serum Hcy level was related to seizure manifestation ( P = 0.034 ) and short-term neurological outcome ( P = 0.027 ). Logistic regression analysis showed that serum glucose (OR 1.897, 95% CI 1.115-3.229; P = 0.018 ) and Hcy level (OR 0.838, 95% CI 0.720-0.976; P = 0.023 ) were significantly associated with short-term disability. Conclusion. Our results indicated that the lower serum Hcy level is strongly associated with in-hospital unfavorable outcome. Further prospective studies of Hcy natural history and managements in bAVMs are required, which would be valuable for evaluating the disease-modifying efficacy of oral nutritional supplements in bAVM patients.

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Modifiable Risk Factors Associated With Moyamoya Disease

Cited by 45 publications

References 43 publications

Epidemiology of Moyamoya disease in China: A nationwide hospital-based study

Epidemiology of Moyamoya disease in China: A nationwide hospital-based study

Plasma Lipid Profiling Contributes to Untangle the Complexity of Moyamoya Arteriopathy

Prognostic Significance of Homocysteine Level on Neurological Outcome in Brain Arteriovenous Malformations

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