Elevated homocysteine and C-reactive protein levels independently predict worsening prognosis after stroke in Chinese patients

Abstract

Summary Increased plasma total homocysteine (tHcy) and high sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular disease. However, the predictive value of tHcy in combination with hsCRP in patients with stroke is not known. To determine the relationship between tHcy and hsCRP, we enrolled 291 patients with first-onset stroke (196 ischemic and 95 hemorrhagic). Plasma tHcy and hsCRP levels were measured and subsequent vascular events and deaths were determined over a 5-year period. Using the arbitrary cutoff for tHcy (<18 μmol/L and ≥18 μmol/L) and hsCRP (<1 mg/L, 1–3 mg/L and >3 mg/L), the patients were divided into 6 groups. Survival analysis showed that the probability of death or new vascular events during a 5-year follow-up increased according to tHcy and hsCRP levels (P<0.01). The relative risk (RR) of death or new vascular events was 4.67 (95% CI, 1.96 to 11.14, P=0.001) in patients with high tHcy (≥18 μmol/L) and hsCRP (>3 mg/L) compared with those with low tHcy (<18 μmol/L) and hsCRP (<1 mg/L). The increased tHcy level (≥18 μmol/L) combined with increased hsCRP level (>3 mg/L) was still significantly associated with the risk of death or new vascular events (RR, 4.10, 95% CI, 1.61 to 10.45, P=0.003) even when adjusted for other risk factors at inclusion. The combination of increased tHcy and hsCRP levels had a stronger predictive value than increased hsCRP alone or increased tHcy level alone. Further studies are required to evaluate the potential decrease in risks associated with lowering both Hcy and hsCRP levels in patients that present with both increased tHcy and hsCRP.

Effect of oral contraceptive therapy on homocysteine and C-reactive protein levels in women: an observational study

“…Youssef et al (23) study demonstrated that high total homocysteine plasma concentration was associated with increased CRP levels in cerebrovascular diseases in an association analysis of a small sample. Also, Jiangtao et al (5) demonstrated this linear association between plasma total homocysteine and CRP levels in a larger sample study on 291 Chinese patients with stroke. In a 5-year follow up study, they showed that increased total homocysteine levels are linearly associated with CRP elevation and they found that higher total homocysteine level combined with higher CRP has much more predictive value for the relative risk factor of death or new vascular events in first-onset stroke patients during long-term follow-up period.…”

“…In a 5-year follow up study, they showed that increased total homocysteine levels are linearly associated with CRP elevation and they found that higher total homocysteine level combined with higher CRP has much more predictive value for the relative risk factor of death or new vascular events in first-onset stroke patients during long-term follow-up period. They also identified that the relative risk factor of death or new vascular events was 4.67 in patients with high homocysteine and CRP levels compared with those with low total homocysteine and CRP concentrations (5).…”

“…Homocysteine is an amino acid that derives from demethylation of methionine. The total serum homocysteine level varies in the range of 5-15 µmol/L in the normal population (5). Either minor genetic abnormalities or nutritional deficiencies of B vitamins such as folic acid involved in metabolism of methionine could lead to increased total homocysteine concentration.…”

“…Homocysteine metabolism may be influenced by dietary habits and lifestyle factors. In particular, homocysteine is inversely related to folate and causes oxidative stress, vascular inflammation, damages endothelial cell, inhibits endothelium-dependent relaxation, and enhances thrombogenecity (5)(6)(7)(8).…”

Prognostic Value of Inflammatory Mediators in 1-Year Outcome of Acute Ischemic Stroke with Middle Cerebral Artery Stenosis

“…Raised levels of markers of the acute inflammatory response after stroke are associated with poor outcomes [8]. Extensive studies demonstrated that the peripheral levels of white blood cell (WBC) [9–11], homocysteine (HCY) [12–15], and C-reactive protein [14, 16–18] strongly correlate with stroke severity and independently predict mortality and stroke recurrence in acute ischemic stroke patients. However, the effect of these biomarkers on intracranial stenosis is unsubstantial, despite significant attribution of intracranial stenoocclusion to stroke severity.…”