Homocysteine, hypertension and stroke

Abstract

The balance of evidence from observational studies suggests that elevated homocysteine levels are associated with increased risk of carotid artery disease and stroke. There is however a paucity of prospective studies. There are also concerns regarding confounding due to factors associated with hyperhomocysteinemia, including renal impairment, an atherogenic diet and cigarette smoking. Homozygosity for a defective thermolabile variant of MTHFR, a common genetic polymorphism which results in hyperhomocysteinemia, has not been consistently linked with stroke or other vascular disease. There is a need for additional prospective studies with data on relevant confounders, sufficient power to characterise the form of the association between homocysteine concentrations and stroke risk, whether linear or threshold, and power to study interactions between homocysteine, other dietary markers and established stroke risk factors such as smoking and

Effects of the angiotensinogen gene M235T and A(-6)G variants on blood pressure and other vascular risk factors in a Spanish population

“…26,27 In our study, mean plasma concentration of homocysteine was raised in the hypertensive group compared to the normotensive one although the difference was not statistically significant. When we distributed the subjects by sex, homocysteine infer a trend to significant difference (t = 1.950; P = 0,05) between the male group with AH (16.98 ± 7.4) and the normotensive males (15.61 ± 5.59).…”

Plasma homocysteine concentration and blood pressure in healthy Iranian adults: the Tehran Homocysteine Survey (2003–2004)

“…39,40 Several studies also showed a significant association between Hcy and BP, [4][5][6][41][42][43][44][45] or HTN; 1,46 however, no association was found in other studies 47,48 (Table 6). Recently, a randomized, placebo-controlled, Hcy-lowering trial reported a decrease in BP in response to treatment.…”

Primary Prevention of Ischemic Stroke

“…207 Although the association between plasma homocyst(e)ine and cerebrovascular risk is biologically plausible, it is more consistently present in case-control studies than in prospective studies, so further confirmatory evidence is required. 199,[207][208][209][210] The OR from NHANES III, when coupled with the prevalence estimates from Selhub et al, 202 gives a population attributable risk of 26% for men aged 40 to 59 years, 35% for men aged Ͼ60 years, 21% for women aged 40 to 59 years, and 37% for women aged Ͼ60 years. These population attributable risk estimates must be interpreted with caution, because no data are available that would permit the estimation of population attributable risk after adjustment for other cerebrovascular risk factors that are positively correlated with homocyst(e)ine levels.…”