Implications of homocysteine levels and carotid intima-media thickness in Indian stroke patients

Year 2023, , 176 - 184, 29.07.2023

Vatsal Navin Jain , Priyanka Rana , Kshitij Arun Bhoge Mohit Vijay Rojekar

https://doi.org/10.46310/tjim.1248356

Cited By: 1

Abstract

Background The study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters. The primary objective was to study the correlation of HCY levels with carotid intima-media thickness (IMT) in stroke patients and investigate if HCY levels had any predictive value for the National Institutes of Health Stroke Scale (NIHSS) score.
Material and Methods Seventy-eight patients of magnetic resonance imaging or computed tomography scans-confirmed acute ischaemic stroke were recruited for this study, and the NIHSS score was evaluated upon admission. Fasting blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of the neck ascertained IMT of common carotid artery (CCA) and internal carotid artery (ICA).
Results The mean age of male and female subjects was 57.88±13.97 and 59.16±13.62 years, respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc), and 24.36% were hyperlipidemic. Patients with NIHSS ≥5 had higher LDL cholesterol than those with NIHSS <5. Positive correlations were found between FBG and CCA IMT and triglyceride and NIHSS. HCY cut off of ≥15 μmol/L had 91.7% sensitivity and 66.7% specificity for predicting NIHSS ≥15. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT and HCY positively correlated with ICA IMT.
Conclusions HHcyc state holds a good predictive value for the severity of stroke. We also concluded that ICA IMT measurement may reduce the need for a HCY test as it predicts higher HCY levels, reducing the burden on resources. We suggest that evaluating HCY and ICA IMT should be part of the standard cerebrovascular accident management protocol.

Keywords

carotid intima-media thickness, homocysteine, stroke

References

• Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Writing Group Members; Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Circulation. 2016 Jan 26;133(4):e38-360. doi: 10.1161/CIR.0000000000000350.
• Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003 Jan;2(1):43-53. doi: 10.1016/s1474-4422(03)00266-7.
• Instructions scale definition score - National Institutes of Health [Internet]. Oct 07, 2022. National Institute of Neurological Disorders and Stroke. National Institutes of Health. Available at: https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf. Accessed Jan 01, 2023.
• Muir KW, Weir CJ, Murray GD, Povey C, Lees KR. Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke. 1996 Oct;27(10):1817-20. doi: 10.1161/01.str.27.10.1817.
• Darabian S, Hormuz M, Latif MA, Pahlevan S, Budoff MJ. The role of carotid intimal thickness testing and risk prediction in the development of coronary atherosclerosis. Curr Atheroscler Rep. 2013 Mar;15(3):306. doi: 10.1007/s11883-012-0306-4.
• Kluijtmans LA, Young IS, Boreham CA, Murray L, McMaster D, McNulty H, Strain JJ, McPartlin J, Scott JM, Whitehead AS. Genetic and nutritional factors contributing to hyperhomocysteinemia in young adults. Blood. 2003 Apr 1;101(7):2483-8. doi: 10.1182/blood.V101.7.2483.
• Dierkes J, Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med. 2005 May;5(2):124-39. doi: 10.1055/s-2005-872398.
• Škovierová H, Vidomanová E, Mahmood S, Sopková J, Drgová A, Červeňová T, Halašová E, Lehotský J. The molecular and cellular effect of homocysteine metabolism imbalance on human health. Int J Mol Sci. 2016 Oct 20;17(10):1733. doi: 10.3390/ijms17101733.
• Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442. doi: 10.1371/journal.pmed.0030442.
• Khan H, Afridi AK, Ashraf S. A hospital based study on stratification of risk factors of stroke in Peshawar. Pak J Med Sci. 2006 Jul-Sep;22(3):304-7.
• Uno M, Harada M, Takimoto O, Kitazato KT, Suzue A, Yoneda K, Morita N, Itabe H, Nagahiro S. Elevation of plasma oxidized LDL in acute stroke patients is associated with ischemic lesions depicted by DWI and predictive of infarct enlargement. Neurol Res. 2005 Jan;27(1):94-102. doi: 10.1179/016164105X18395.
• Jain VN, Ghangurde S, Carvalho SR, Nirgudkar SS, Rojekar MV. Effect of thyroid hormone levels on glycemic control: The Indian context. Iran J Diabetes Obes. 2022; 14(3):131-7. doi: 10.18502/ijdo.v14i3.10738.
• Brohall G, Odén A, Fagerberg B. Carotid artery intima-media thickness in patients with Type 2 diabetes mellitus and impaired glucose tolerance: a systematic review. Diabet Med. 2006 Jun;23(6):609-16. doi: 10.1111/j.1464-5491.2005.01725.x.
• Stein JH, McBride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. off. Arch Intern Med. 1998 Jun 22;158(12):1301-6. doi: 10.1001/archinte.158.12.1301.
• Bostom AG, Rosenberg IH, Silbershatz H, Jacques PF, Selhub J, D'Agostino RB, Wilson PW, Wolf PA. Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham Study. Ann Intern Med. 1999 Sep 7;131(5):352-5. doi: 10.7326/0003-4819-131-5-199909070-00006.
• Christopher R, Nagaraja D, Shankar SK. Homocysteine and cerebral stroke in developing countries. Curr Med Chem. 2007;14(22):2393-401. doi: 10.2174/092986707781745613.
• Yang F, Tan HM, Wang H. Hyperhomocysteinemia and atherosclerosis. Sheng Li Xue Bao. 2005 Apr 25;57(2):103-14.
• Durga J, Verhoef P, Bots ML, Schouten E. Homocysteine and carotid intima-media thickness: a critical appraisal of the evidence. Atherosclerosis. 2004 Sep;176(1):1-19. doi: 10.1016/j.atherosclerosis.2003.11.022.
• Wu W, Guan Y, Xu K, Fu XJ, Lei XF, Lei LJ, Zhang ZQ, Cheng Y, Li YQ. Plasma homocysteine levels predict the risk of acute cerebral infarction in patients with carotid artery lesions. Mol Neurobiol. 2016 May;53(4):2510-7. doi: 10.1007/s12035-015-9226-y.
• Dietrich M, Jacques PF, Polak JF, Keyes MJ, Pencina MJ, Evans JC, Wolf PA, Selhub J, Vasan RS, D'Agostino RB. Segment-specific association between plasma homocysteine level and carotid artery intima-media thickness in the Framingham Offspring Study. J Stroke Cerebrovasc Dis. 2011 Mar-Apr;20(2):155-61. doi: 10.1016/j.jstrokecerebrovasdis.2009.10.012.
• Kwon HM, Lee YS, Bae HJ, Kang DW. Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke. 2014 Mar;45(3):871-3. doi: 10.1161/STROKEAHA.113.004099.
• Wu XQ, Ding J, Ge AY, Liu FF, Wang X, Fan W. Acute phase homocysteine related to severity and outcome of atherothrombotic stroke. Eur J Intern Med. 2013 Jun;24(4):362-7. doi: 10.1016/j.ejim.2013.01.015.
• Spence JD. Nutrition and stroke prevention. Stroke. 2006 Sep;37(9):2430-5. doi: 10.1161/01.STR.0000236633.40160.ee.
• Naruszewicz M, Klinke M, Dziewanowski K, Staniewicz A, Bukowska H. Homocysteine, fibrinogen, and lipoprotein(a) levels are simultaneously reduced in patients with chronic renal failure treated with folic acid, pyridoxine, and cyanocobalamin. Metabolism. 2001 Feb;50(2):131-4. doi: 10.1053/meta.2001.20174.
• Spence JD. Homocysteine-lowering therapy: a role in stroke prevention? Lancet Neurol. 2007 Sep;6(9):830-8. doi: 10.1016/S1474-4422(07)70219-3.
• Sánchez-Moreno C, Jiménez-Escrig A, Martín A. Stroke: roles of B vitamins, homocysteine and antioxidants. Nutr Res Rev. 2009 Jun;22(1):49-67. doi: 10.1017/S0954422409990023.
• Sainani GS, Talwalkar PG, Wadia RS, Keshvani AA. Hyperhomocysteinemia and its implications in atherosclerosis the Indian Scenario. In: Singal RK, ed. Medicine Update. 1st ed. New Delhi, India: Jaypee Brothers Medical Publishers Ltd.; 2007;17:11-20. doi: 10.5005/jp/books/12086_3.
• Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens. 2002 Feb;20(2):159-69. doi: 10.1097/00004872-200202000-00001.