Hyperhomocysteinemia independently associated with adult moyamoya disease: hospital based study of 237 patients

Abstract

To clarify the risk factors for adult moyamoya disease (MMD) in patients from South China. MATERIAL and METHODS: We prospectively studied adult patients who were diagnosed angiographically with MMD. The demographic profiles, medical history and clinical characteristics were compared between adult MMD and non-MMD stroke patients. Logistic regression analysis was used to determine the risk factors associated with adult MMD. RESULTS: A total of 35 adult MMD patients and 202 adults patients with non-MMD stroke were included. Of the 35 MMD patients, bilateral MMD occurred in 48.6% and bypass surgery was performed in 28.6%; these figures were significantly lower than those reported in patients from Korea and the United States (p<0.05). After adjusting for baseline demographics and potential confounders, multivariate logistic regression analysis was conducted, which showed that the plasma homocysteine level (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.06-1.14) and occupation as a technological worker (OR: 4.23; 95% CI: 1.65-10.89) were independently associated with adult MMD. CONCLUSION: Hyperhomocysteinemia and type of occupation were found to be independent risk factors for adult MMD in patients from South China. However, there is still a need for further research to clarify the pathogenesis of MMD. Given the lack of understanding about the risk factors and prevention measures for MMD, we suggest bypass surgery be used for MMD treatment in clinical practice in China to achieve more desirable effects in the management of the disease.

Integrated analysis of the association between methionine cycle and risk of moyamoya disease

“…In previous genome‐wide association study, researchers identified MTHFR and TCN2, two Hcy metabolism regulatory genes, as novel susceptibility genes for MMD, which were significantly associated with high‐serum Hcy levels in MMD 33 . Previous case–control studies identified the positive association between Hcy, HHcy, and the risk of MMD 16,17 . Furthermore, HHcy has been found correlated to postoperative ischemia and poor postoperative angiogenesis in MMD patients 34,35 .…”

“… 33 Previous case–control studies identified the positive association between Hcy, HHcy, and the risk of MMD. 16 , 17 Furthermore, HHcy has been found correlated to postoperative ischemia and poor postoperative angiogenesis in MMD patients. 34 , 35 Growing evidence has shown that MMD was associated with oxidative stress and chronic inflammation.…”

“…The altered levels of Met cycle‐related metabolites played a crucial role in the pathogenesis and progression of cardiovascular and cerebrovascular diseases 14,15 . The correlation between homocysteine (Hcy) and MMD has been discussed in previous studies 16,17 . Furthermore, the association between decreased levels of choline and betaine and the risk of MMD has been recently identified 18 .…”

“… 14 , 15 The correlation between homocysteine (Hcy) and MMD has been discussed in previous studies. 16 , 17 Furthermore, the association between decreased levels of choline and betaine and the risk of MMD has been recently identified. 18 It indicated the complex interactions between the Met cycle and the risk of MMD.…”