Homocysteine Levels in Patients with Hemorrhagic Stroke

Year 2023, , 101 - 105, 16.04.2023

Aysu Yetiş , Asuman Çelikbilek , Aysel Kaya Tekeşin , Orhan Yağız

https://doi.org/10.46332/aemj.1069981

Abstract

Purpose: Accumulating data demonstrated that raised homocysteine is a risk factor for ischemic stroke. However, it remains unclear whether high homocysteine level is also a risk factor for hemorrhagic stroke, which accounts for about one-fifth of stroke patients. Our aim was to measure the plasma homocysteine levels in patients with hemorrhagic stroke to explore a possible link.

Materıals and Methods: We included thirty patients with ischemic stroke, thirty patients with hemorrhagic stroke, and thirty healthy volunteers. All participants were examined for traditional risk factors and levels of folic acid, homocysteine, and vitamin B12.

Results: Hypertension was higher in both ischemic stroke and hemorrhagic stroke patients than in healthy participants (p=0.029). Homocysteine levels were significantly higher in both ischemic stroke and hemorrhagic stroke groups than in the control group (p=0.001), with no statistically difference between each other (p>0.05). Vitamin B12 levels were significantly lower in both ischemic stroke and hemorrhagic stroke patients than in the controls (p=0.001), with no statistically difference between each other (p>0.05). Folic acid levels did not significantly differ between the groups (p>0.05). We did not find correlation between homocysteine, vitamin B12 and folic acid levels (p>0.05).

Conclusion: Our study indicated that the homocysteine levels were high in patients with hemorrhagic stroke. Larger cohorts are needed to clarify the role of homocysteine in hemorrhagic stroke.

Keywords

hemorragic stroke, homocysteine, vitamin B12, folic acid

Hemorajik İnmeli Hastalarda Homosistein Düzeyleri

Abstract

Amaç: Biriken veriler, artan homosistein iskemik inme için bir risk faktörü olduğunu göstermiştir. Ancak, yükselmiş homosistein seviyesinin, inme hastalarının yaklaşık beşte birini oluşturan hemorajik inme için de bir risk faktörü olup olmadığı belirsizdir. Amacımız, olası bir bağlantıyı araştırmak için hemorajik inmeli hastalarda plazma homosistein düzeylerini ölçmekti.

Araçlar ve Yöntem: Çalışmaya otuz iskemik inmeli hasta, otuz hemorajik inmeli hasta ve otuz sağlıklı gönüllü aldık. Bütün hastalar, konvansiyonel risk faktörleri ve homosistein, vitamin B12 ve folik asit düzeyleri açısından incelendi.

Bulgular: Hipertansiyon, hem iskemik inme hem de hemorajik inme hastalarında sağlıklı katılımcılara göre daha yüksekti (p=0.029). Homosistein düzeyleri, hem iskemik inme hem de hemorajik inme gruplarında kontrol grubuyla karşılaştırıldığında istatistiki olarak yüksek bulundu (p=0.001) ve aralarında istatistiki olarak anlamlı bir farklılık yoktu (p>0.05). B12 vitamini düzeyleri hem iskemik inme hem de hemorajik inme hastalarında kontrollere göre anlamlı olarak daha düşüktü (p=0.001) ve aralarında istatistiksel olarak fark yoktu (p>0.05). Folik asit seviyeleri açısından gruplar arasında istatistiki olarak anlamlı bir farklılık bulunmadı (p>0.05). Homosistein, vitamin B12 ve folik asit düzeyleri arasında korelasyon bulunmadı (p>0.05).

Sonuç: Çalışmamız, hemorajik inme hastalarında homosistein düzeylerinin yüksek olduğunu göstermiştir. Hemorajik inmede homosisteinin rolünü netleştirmek için daha büyük kohortlara ihtiyaç vardır.

Keywords

hemorajik inme, homosistein, folik asit, B12 vitamini

References

• 1. Azad MAK, Huang P, Liu G, ve ark. Hyperhomocysteinemia and cardiovascular disease in animal model. Amino Acids. 2018;50(1):3-9.
• 2. Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Meta-analysis. TH Open. 2021;5(3):e420-e437.
• 3. Holmes MV, Newcombe P, Hubacek JA, ve ark. Effect modification by population dietary folate on the association between MTHFR genotype, homocysteine, and stroke risk: a meta-analysis of genetic studies and randomised trials. Lancet. 2011;378(9791):584-594.
• 4. Lehotský J, Tothová B, Kovalská M, ve ark. Role of Homocysteine in the Ischemic Stroke and Development of Ischemic Tolerance. Front Neurosci. 2016;10:538.
• 5. Li Q, Zhao Z, Si K, ve ark. Correlation between the levels of NLRP3, Hcy, IL-1β, IL-18 and the prognosis in patients with hemorrhagic stroke. Am J Transl Res. 2021;13(4):2883-2890.
• 6. Zeng C, Lin F, Ge P, Zhang D, Wang S, Zhao J. Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations. Dis Markers. 2021;2021:8862299.
• 7. Zhou Z, Liang Y, Qu H, ve ark. Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis. Sci Rep. 2018;8(1):2568.
• 8. Frontera JA, Starling R, Cho SM, ve ark. Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices. J Heart Lung Transplant. 2017;36(6):673-683.
• 9. Chen G, Ping L, Zhou S, ve ark. Early prediction of death in acute hypertensive intracerebral hemorrhage. Exp Ther Med. 2016;11(1):83-88.
• 10. Al-Khaled M, Eggers J. Prognosis of intracerebral hemorrhage after conservative treatment. J Stroke Cerebrovasc Dis. 2014;23(2):230-234.
• 11. Iso H, Moriyama Y, Sato S, ve ark. Serum total homocysteine concentrations and risk of stroke and its subtypes in Japanese. Circulation. 2004;109(22):2766-2772.
• 12. Zhou F, Chen B, Chen C, ve ark. Elevated homocysteine levels contribute to larger hematoma volume in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2015;24(4):784-788.
• 13. Yao ES, Tang Y, Xie MJ, Wang MH, Wang H, Luo X. Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke. Med Sci Monit. 2016;22:3268-3273.
• 14. Karakurum Goksel B, Karatas M, Nebioglu A, ve ark. Subclinical hypothyroidism, hyperhomocysteinemia and dyslipidemia: investigating links with ischemic stroke in Turkish patients. Neurol Res. 2007;29(8):871-876.
• 15. Celikbilek A, Goksel BK, Zararsiz G, Benli S. Spontaneous intra-cerebral hemorrhage: A retrospective study of risk factors and outcome in a Turkish population. J Neurosci Rural Pract. 2013;4(3):271-277.
• 16. Ahmadinejad N, Movahedinia S, Movahedinia S, Shahriari M. Association of mammographic density with pathologic findings. Iran Red Crescent Med J. 2013;15(12):e16698.
• 17. Jeon SB, Kang DW, Kim JS, Kwon SU. Homocysteine, small-vessel disease, and atherosclerosis: an MRI study of 825 stroke patients. Neurology. 2014;83(8):695-701.
• 18. Kalra DK. Homocysteine and cardiovascular disease. Curr Atheroscler Rep. 2004;6(2):101-106.
• 19. Moretti R, Giuffré M, Caruso P, Gazzin S, Tiribelli C. Homocysteine in Neurology: A Possible Contributing Factor to Small Vessel Disease. Int J Mol Sci. 2021;22(4):2051.
• 20. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. Bmj. 2002;325(7374):1202.
• 21. Yang G, Shao G. Clinical effect of minimally invasive intracranial hematoma in treating hypertensive cerebral hemorrhage. Pak J Med Sci. 2016;32(3):677-681.
• 22. Chen S, Dong Z, Cheng M, ve ark. Homocysteine exaggerates microglia activation and neuroinflammation through microglia localized STAT3 overactivation following ischemic stroke. J Neuroinflammation. 2017;14(1):1-12.
• 23. Wiernicki I, Millo B, Safranow K, Gorecka-Szyld B, Gutowski P. MMP-9, homocysteine and CRP circulating levels are associated with intraluminal thrombus thickness of abdominal aortic aneurysms: new implication of the old biomarkers. Dis Markers. 2011;31(2):67-74.
• 24. Min H, Hong J, Cho IH, ve ark. TLR2-induced astrocyte MMP9 activation compromises the blood brain barrier and exacerbates intracerebral hemorrhage in animal models. Mol Brain. 2015;8(1):1-14.
• 25. Dhandapani S, Goudihalli S, Mukherjee KK, ve ark. Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: a case for the reverse epidemiology paradox? Acta Neurochir (Wien). 2015;157(3):399-407.
• 26. Suo Y, Chen W, Pan Y, ve ark. Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Hematoma Expansion of Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis. 2018;27(7):2006-2013.
• 27. Sato S, Uehara T, Hayakawa M, Nagatsuka K, Minematsu K, Toyoda K. Intra- and extracranial atherosclerotic disease in acute spontaneous intracerebral hemorrhage. J Neurol Sci. 2013;332(1-2):116-120.
• 28. Al-Delaimy WK, Rexrode KM, Hu FB, ve ark. Folate intake and risk of stroke among women. Stroke. 2004;35(6):1259-1263.