Plasma homocysteine is a risk factor for recurrent vascular events in young patients with an ischaemic stroke or TIA

Bos, Michiel J.; Goor, M; Koudstaal, Peter J.; Dippel, Diederik W.J.

doi:10.1007/s00415-005-0647-9

Cited by 20 publications

(9 citation statements)

References 15 publications

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“…It is suggested that the possible cause is oxidative stress and inflammatory cytokines produced through the renin-angiotensin-aldosterone system [19,20]. An additional consideration is the significantly high plasma homocysteine level common to patients with kidney disease, [21] as patients with higher levels of homocysteine more readily develop cerebrovascular disease [22][23][24]. Various points are also becoming clear regarding local cerebral ischemia, as suggested by subsequent vascular damage.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases

Nakabou¹,

Kai²,

Maeshima³

et al. 2009

Clin Exp Nephrol

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We herein report two cases of patients with chronic kidney disease who developed hypertensive encephalopathy, which occurred after a sudden discontinuance of antihypertensive agents. Both patients underwent care at our hospital after experiencing neurological abnormalities. In both patients, magnetic resonance imaging (MRI) revealed edema in the cerebral white matter and cortices, basal ganglia, brainstem, and cerebellum. Though recently the number of reports about hypertensive encephalopathy has decreased, we describe two case reports and also review the pertinent literature.

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Section: Discussionmentioning

confidence: 99%

Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases

Nakabou¹,

Kai²,

Maeshima³

et al. 2009

Clin Exp Nephrol

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“…Plasma homocysteine is a risk factor for recurrent vascular events in young patients with ischaemic stroke or TIA [21] . This body of evidence suggests that lowering the tHcy level, such as with folic acid and vitamin B12 supplementation, could reduce the risk of cardiovascular events, including stroke.…”

Section: Discussionmentioning

confidence: 99%

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

Yan

Liao

Wang

2010

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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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.

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“…9 It must, however, be pointed out that these trials had a subject mean age of 66 to 68 years, and although other trials are ongoing, 10 it is possible that relatively younger adults may benefit more from such treatment. 11,12 Indeed, a detailed review of the HOPE-2 trial data and reanalysis of the VISP trial restricted to patients capable of responding to vitamin therapy indicated that higher doses of vitamin B12 and possibly novel methods of reducing total HCY besides routine vitamin therapy could potentially reduce the risk of stroke. 13 This notion is further supported by a recent metaanalyses suggesting that the benefit of HCY-lowering in reducing stroke risk may not apply broadly, but to targeted groups of individuals.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Steep Increase in Late Midlife Stroke Occurrence among US Men

Towfighi

Saver

Engelhardt

et al. 2008

Journal of Stroke and Cerebrovascular Diseases

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Plasma homocysteine is a risk factor for recurrent vascular events in young patients with an ischaemic stroke or TIA

Cited by 20 publications

References 15 publications

Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases

Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases

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

Factors Associated with the Steep Increase in Late Midlife Stroke Occurrence among US Men

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