Plasma Homocysteine in the Acute and Convalescent Phases After Stroke

Lindgren, Arne; Brattström, Lars; Norrving, Bo; Hultberg, Björn; Andersson, Anders; Johansson, Barbro

doi:10.1161/01.str.26.5.795

Cited by 193 publications

(133 citation statements)

References 31 publications

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“…However, in vivo studies are contradictory (Dudman et al 1993a;Mansoor et al 1995;Young et al 1997). Homocysteine readily undergoes auto-oxidation in plasma (Velury & Howell, 1988;Stamler et al 1993;Andersson et al 1995) forming reactive oxygen species such as H 2 O 2 and superoxide, which may themselves cause oxidation of LDL (Heinecke et al 1987), and other products such as cysteinehomocysteine mixed disulfides, and homocysteine thiolactone. It has been proposed that homocysteine thiolactone reacts with LDL to form LDL-homocysteine thiolactone aggregates, which may then be taken up by macrophages and subsequently incorporated into foam cells in early atherosclerotic plaques (Naruszewicz et al 1994;Jakubowski, 1997;Ferguson et al 1999).…”

Section: Atherosclerotic Mechanismsmentioning

confidence: 99%

Nutritional aspects and possible pathological mechanisms of hyperhomocysteinaemia: an independent risk factor for vascular disease

McKinley

2000

Proc. Nutr. Soc.

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Numerous case–control and prospective studies have identified elevated plasma homocysteine as a strong independent risk factor for cerebovascular, cardiovascular and peripheral vascular disease. Homocysteine is formed as a result of the breakdown of the dietary amino acid methionine. Once formed, homocysteine is either remethylated to methionine, or undergoes a trans-sulfuration reaction to form cysteine. The re-methylation of homocysteine to methionine is dependent on three B-vitamins, i.e. riboflavin, vitamin B12and folate. The second pathway of homocysteine metabolism is the trans-sulfuration pathway which requires both vitamin B6and riboflavin for its activity. Thus, up to four B-vitamins are required for intracellular homocysteine metabolism. Many studies have noted strong inverse relationships between homocysteine levels and the status of both vitamin B12and folate. However, the relationship between vitamin B6status and homocysteine is still uncertain. Similarly, numerous intervention studies have demonstrated effective lowering of homocysteine levels as a result of folate and vitamin B12supplementation, while the homocysteine-lowering ability of vitamin B6is unclear. Even though riboflavin plays a crucial role in both the trans-sulfuration and remethylation pathways of homocysteine metabolism, the relationship between riboflavin status and homocysteine levels has not been investigated. The exact mechanism that explains the vascular toxicity of elevated homocysteine levels is unknown at present, studies indicate that it is both atherogenic and thrombogenic. To date, no randomized clinical trial has demonstrated that lowering of homocysteine levels is beneficial in terms of reducing the prevalence of vascular disease. It is probable, however, that optimal B-vitamin status is important in the prevention of vascular disease.

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Section: Atherosclerotic Mechanismsmentioning

confidence: 99%

Nutritional aspects and possible pathological mechanisms of hyperhomocysteinaemia: an independent risk factor for vascular disease

McKinley

2000

Proc. Nutr. Soc.

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“…1,2 However, this finding could reflect an effect rather than the cause, because homocysteine concentrations may increase after the onset of acute stroke. 3 Thus, to reduce this bias, data from prospective studies are desirable. However, the findings from prospective studies have been inconsistent.…”

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confidence: 99%

Serum Total Homocysteine Concentrations and Risk of Stroke and Its Subtypes in Japanese

et al. 2004

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Background-To date, no prospective studies have examined the association between serum homocysteine levels and the risk of stroke and stroke subtypes in Asian populations. Methods and Results-A prospective, nested, case-control study of Japanese subjects 40 to 85 years of age was conducted by using frozen serum samples from 11 846 participants in cardiovascular risk surveys collected from 1984 to 1995 for one community and 1989 to 1995 for the other two communities. By the end of 2000, we identified 150 incident strokes, the subtypes of which were confirmed by imaging studies. Three control subjects per case were selected by matching for sex, age, community, year of serum storage, and fasting status. Serum total homocysteine levels were measured by high-performance liquid chromatography. Compared with control subjects, total (nϭ150), hemorrhagic (nϭ52), and ischemic (nϭ98) strokes had higher geometric mean values of total homocysteine and higher proportions of homocysteine Ն11.0 mol/L. The multivariate odds ratios (95% CI) for highest (Ն11.0 mol/L) versus lowest quartiles (Ͻ7.0 mol/L) of homocysteine after adjustment for body mass index, smoking, alcohol intake, hypertension, serum total cholesterol, and other cardiovascular risk factors were 2.99 (1.51 to 5.93) for total stroke, 3.89 (1.60 to 9.46) for ischemic stroke, 3.36 (1.27 to 8.90) for lacunar infarction, and 1.63 (0.44 to 6.00) for hemorrhagic stroke. The respective multivariate odds ratios associated with a 5-mol/L increase in homocysteine were 1.40 (1.09 to 1.80), 1.52 (1.07 to 2.14), 1.48 (1.01 to 2.18), and 1.10 (0.76 to 1.59). The excess risk of total and ischemic strokes did not vary significantly according to sex, age, smoking status, or hypertensive status. Conclusions-High total homocysteine concentrations were associated with the increased risk of total stroke, more specifically ischemic stroke and lacunar infarction, among Japanese men and women.

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“…High levels of homocysteine are correlated with significant increase risk of CAD, MI [80], peripheral occlusive disease (deep vein thrombosis) [81,82], and intermittent claudication [83]. According to Nygard et al [84], a serum homocysteine level of 12% greater than the upper limit of normal is associated with a threefold increased risk of acute MI.…”

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confidence: 99%

Micronutrient Vitamin Deficiencies and Cardiovascular Disease Risk: Advancing Current Understanding

Ekpenyong¹

2017

EJPM

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Cardiovascular diseases are responsible for one-third of all deaths in the world. Several factors contribute to the current trend including micronutrient vitamin deficiencies (MVDs), however, opinions regarding the role of MVDs in CVDs are inconsistent; this could impact on micronutrient vitamins intake. The aim of this review was to provide a brief overview of published evidence on the associations between MVDs and CVDs, assess the interactions between micronutrients and cardiovascular endpoints, and identify current related research needs. Literature search conducted on studies published between 1963 and 2016 indicates that MVDs are common and are related to adverse cardiovascular endpoints through various mechanisms, including impaired antioxidant and immune response mechanisms; and anti-inflammatory activities. Some micronutrients directly impact on CVDs; others act as critical cofactors in several biochemical processes. Several methodologic flaws, environmental and individual susceptibility factors, lack of determination of baseline serum levels of complementary micronutrients, absence of uniformly accepted cut-off values, and interactions between micronutrients may partly account for discordant results across studies. Although MVD is a significant risk factor for CVDs, supplementation with single or paired micronutrients for primary prevention of CVDs in healthy adults with no special nutritional needs is discouraged; there is insufficient evidence to determine the benefit/harm of such supplementation.

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Plasma Homocysteine in the Acute and Convalescent Phases After Stroke

Cited by 193 publications

References 31 publications

Nutritional aspects and possible pathological mechanisms of hyperhomocysteinaemia: an independent risk factor for vascular disease

Nutritional aspects and possible pathological mechanisms of hyperhomocysteinaemia: an independent risk factor for vascular disease

Serum Total Homocysteine Concentrations and Risk of Stroke and Its Subtypes in Japanese

Micronutrient Vitamin Deficiencies and Cardiovascular Disease Risk: Advancing Current Understanding

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