Prognostic Significance of Homocysteine Levels in Acute Ischemic Stroke: A Prospective Cohort Study

Yan, Jing; Song, Bo; Xu, Yuming; Fang, Hui; Wu, Jun; Sun, Shilei; Zhao, Lu; Shi, Changhe; Yuan, Gao; Tao, Yongli; Li, Yapeng

doi:10.2174/1567202612666150807112205

Cited by 18 publications

(14 citation statements)

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“…A prospective cohort study of Ji et al supported the atherogenic role of Hcy. An elevated Hcy level can represent a sensitive predictor for severe neurological impairment, a poor functional outcome, and stroke recurrence in large artery atherosclerosis stroke subtype [ 25 ]. Several previous cohort studies such as the Northern Manhattan cohort study, the Framingham Study and the British Regional Heart Study also demonstrate elevated plasma Hcy was associated with an increased risk of ischemic stroke [ 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Plasma homocysteine levels and intracranial plaque characteristics: association and clinical relevance in ischemic stroke

Xie

et al. 2018

BMC Neurol

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BackgroundElevated plasma homocysteine (Hcy) is an independent risk factor for ischemic stroke. This study aimed to evaluate the association between Hcy levels and intracranial plaque characteristics and to investigate their clinical relevance in ischemic stroke.MethodsNinety-four patients with intracranial atherosclerosis (ICAS) were enrolled. Plasma Hcy levels were measured. Intracranial plaque characteristics including plaque enhancement, stenosis ratio, T2 and T1 hyperintense components were assessed on high-resolution magnetic resonance imaging. Logistic regression model was constructed to analyze the association between high Hcy levels and plaque characteristics, and their synergistic effects to predict the likelihood for ischemic stroke, while adjusting for demographics and traditional atherosclerotic risk factors.ResultsElevated Hcy level was associated with strong plaque enhancement independently of age, sex, serum creatinine levels and other atherosclerotic risk factors ((P < 0.001, OR 6.00, 95% confidence interval [CI] 2.28–15.74). Both strong plaque enhancement (P = 0.026, OR 5.63, 95% CI 1.23–25.81) and high Hcy level (P = 0.018, OR 6.20, 95% CI 1.36–28.26) were correlated with acute ischemic stroke. The combination of them strengthened the ability to stratify the likelihood for ischemic stroke, with an improved area under the receiver operating characteristic curve (AUC) of 0.871, significantly higher than that of strong plaque enhancement (0.755) and high Hcy level (0.715) alone (P < 0.05 for both).ConclusionsHigh Hcy level appears to have association with intracranial strong plaque enhancement. The combined assessment of plasma Hcy levels and plaque enhancement may improve ischemic stroke risk stratification.

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Section: Discussionmentioning

confidence: 99%

Plasma homocysteine levels and intracranial plaque characteristics: association and clinical relevance in ischemic stroke

Xie

et al. 2018

BMC Neurol

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“…Toole et al [ 15 ] showed that a decrease of 3 μmol/L in total Hcy level was associated with a 10% lower risk of stroke. Based on the ROC model, we determined that out the cut-off value for Hcy was 19.95 μmol/L, and a similar cut-off value for Hcy (17.64 μmol/L) was reported by Yan et al [ 16 ]. A cut-off value of 19.95 μmol/L of Hcy can be used as an index to predict poor prognosis in patients with AIS after thrombolysis treatment.…”

Section: Discussionmentioning

confidence: 57%

Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke

et al. 2016

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BackgroundHyperhomocysteinemia (HHcy) is a well-known risk factor for ischemic stroke. However, whether HHcy can influence the treatment outcome of acute ischemic stroke (AIS) patients has yet to be fully determined. In this study, we investigated the relationship between serum homocysteine (Hcy) level and prognosis in AIS patients who received tissue plasminogen activator (tPA) treatment.Material/MethodsPatients were recruited according to the research criteria and grouped by their serum Hcy levels. Neurological outcome was evaluated by National Institute of Health Stroke Scale (NIHSS) score system before and 1 week after treatment, and functional outcome was evaluated by modified Rankin Scale (MRS) score system after 3 months. All patients took CT/MRI examination to detect cerebral hemorrhage in 24 hours after tPA treatment. Receiver operating characteristic curve (ROC) was employed to assess if serum homocysteine level can be used as an index to predict the outcome after tPA treatment.ResultsThe mean (±SD) serum Hcy level of 194 patients was 22.62±21.23 μmol/L. After 1-week tPA treatment, the NIHSS scores of high Hcy level group were significantly higher than those of low level group (p<0.05), meantime the high Hcy group showed obvious symptomatic intracerebral hemorrhage risk after 24 hours (p<0.05). Poor outcome was presented in mRS score results after 3 months in high Hcy level group, which compared with low Hcy level group (p<0.01). The ROC showed that Hcy level was a moderately sensitive and specific index to predict the prognosis with an optimal cut-off value at 19.95 μmol/L (sensitivity [58.2%], specificity [80.3%]).ConclusionsHigh serum homocysteine level could potentially predict poor prognosis in acute ischemic stroke patients after tPA treatment.

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“…Wu et al (2016) demonstrated that high Hcy levels were associated with a greater incidence of acute cerebral infarction among patients with carotid artery plaques. Ji et al (2015) reported that high Hcy levels were associated with a poor functional outcome, severe neurological impairment and stroke recurrence in large artery atherosclerosis stroke subtype, which confirmed the atherogenic effect of Hcy. Lu et al (2018) demonstrated that high Hcy levels were correlated with strong plaque enhancement and acute ischemic stroke with adjustment for sex, age, serum creatinine levels and other atherosclerotic risk factors.…”

Section: Discussionmentioning

confidence: 73%

Single nucleotide polymorphism of MTHFR rs1801133 associated with elevated Hcy levels affects susceptibility to cerebral small vessel disease

Yuan

Yang

et al. 2020

PeerJ

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Background Methylenetetrahydrofolate reductase (MTHFR) is indispensable for the conversion of homocysteine (Hcy) to methionine. The single nucleotide polymorphism (SNP) of MTHFR gene (rs1801133, C667T) is correlated with decreased enzyme activity that eventually results in elevated plasma Hcy levels. Hyperhomocysteinemia has been confirmed to be involved in the pathogenesis of stroke, cerebral small vessel disease (CSVD), various metabolic disorders and so on. However, the relationship between the MTHFR gene polymorphisms, Hcy, and CSVD has not been investigated. In this study, the relationship between SNPs of MTHFR gene and CSVD was determined after adjusting for cardiovascular risk factors, and the potential mechanism based on Hcy levels was explored. Methods A total of 163 consecutive CSVD patients were collected as the case group. In the corresponding period, 326 healthy people were selected as the control group, who were matched to these cases according to age (±2 years) and gender at a ratio of 2:1. SNPs of MTHFR rs1801133, rs1801131, rs2274976, rs4846048, rs4846049, rs13306561 and rs3737964, were genotyped with TaqMan Pre-Designed SNP Genotyping Assays. Plasma Hcy levels were detected using Hcy reagent through enzymatic cycling assay. Multivariate analysis was used to identify the SNPs associated with CSVD susceptibility. Plasma Hcy levels were compared between different genotypes. Results The MTHFR rs1801133 TT and CT genotype had increased risk for CSVD, and the OR was higher in the TT genotype than in the CT genotype (2.307 vs 1.473). The plasma Hcy levels of different genotypes showed the tendency of the TT genotype > CT genotype > CC genotype (19.91 ± 8.73 pg/ml vs 17.04 ± 5.68 pg/ml vs 14.96 ± 4.85 pg/ml). Conclusions The SNP of MTHFR rs1801133 was correlated with CSVD, and the TT and CT genotypes had increased risk for CSVD compared to the CC genotype. The potential mechanism was associated with elevated Hcy levels.

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Prognostic Significance of Homocysteine Levels in Acute Ischemic Stroke: A Prospective Cohort Study

Cited by 18 publications

References 0 publications

Plasma homocysteine levels and intracranial plaque characteristics: association and clinical relevance in ischemic stroke

Plasma homocysteine levels and intracranial plaque characteristics: association and clinical relevance in ischemic stroke

Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke

Single nucleotide polymorphism of MTHFR rs1801133 associated with elevated Hcy levels affects susceptibility to cerebral small vessel disease

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