Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis

Abstract

Background High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. Methods We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of τ2 through the DerSimonian-Laird method. Results The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00–2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I2 = 99%), particularly because three studies showed significantly large mean differences. Conclusion This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.

Serum 5-Methyltetrahydrofolate Status Is Associated with One-Carbon Metabolism-Related Metabolite Concentrations and Enzyme Activity Indicators in Young Women

“…The excess Hcy is then excreted from the cells, leading to its increased concentration in the circulation [ 16 , 22 ]. High plasma Hcy concentrations have been linked to cardiovascular diseases [ 23 , 24 ], stroke [ 25 , 26 ], Alzheimer’s disease [ 27 , 28 ], schizophrenia [ 29 , 30 ], macular degeneration [ 31 ], diabetes [ 32 ], fractures [ 33 ], pregnancy complications [ 34 , 35 , 36 ], small-for-gestational-age offspring [ 37 ], and cancer [ 38 ]. This suggests that Hcy is an important indicator of health status [ 39 , 40 ].…”

Vitamin B12, folate, and homocysteine in metabolic syndrome: a systematic review and meta-analysis

“…Several studies have documented the association between Hcy and MetS ( 62 , 64 ), and Hcy has even been proposed as a marker ( 40 ). Increased levels of Hcy were shown to be associated with cardiovascular death ( 64 ), stroke ( 117 ), and obesity ( 118 ). Nonetheless, it is important to note that the high levels of Hcy in patients with MetS could be iatrogenic, as most hypolipidemic, antidiabetic, and antihypertensive drugs raise circulating Hcy levels ( 119 ).…”

The Interplay of Dyslipidemia, Oxidative Stress, and Clinical Outcomes in Acute Ischemic Stroke Patients with and without Coronary Artery Disease

“…Elevated homocysteine levels are associated with an increased risk of atherosclerosis and coronary heart disease [23,24]. However, the relationship between homocysteine and AIS in CAD patients is complex and influenced by various factors, including genetic predisposition and impaired folate metabolism [25,26]. Elevated homocysteine levels found in CAD-AIS patients can promote inflammation and endothelial dysfunction, leading to a higher risk of thrombosis [27].…”