Homocysteine Levels and Ischemic Stroke: A Systematic Review
Journal of Cellular & Molecular Anesthesia,
Vol. 6 No. 3 (2021),
7 Shahrivar 2021
,
Page 269-275
https://doi.org/10.22037/jcma.v6i3.33877
Abstract
The most common type of stroke is ischemic stroke. Given that death due to stroke is one of the three leading causes of death globally, it is essential to identify its risk factors, especially modifiable risk factors. Nowadays, High homocysteine is recognized as one of the risk factors for stroke. Our aim in this study was to investigate the association between homocysteine levels and ischemic stroke. We searched the keywords in Scopus, Web of Science, Google Scholar, PubMed, and Science Direct with a 15-year time limit. At first, 3884 studies were found, and after further investigation and based on inclusion and exclusion criteria, only nine studies were selected. Of the nine selected studies was a clinical trial and eight observational studies, and in total, there were 16227 participants in these studies. The prevalence of ischemic stroke was higher in people with high homocysteine levels than in people with normal homocysteine levels (14.1% vs. 9.8%). The prevalence was generally higher in men, but among people with high homocysteine levels, the prevalence of ischemic stroke was slightly higher in women than in men (12% vs. 11%), and also, in women and men, the prevalence of ischemic stroke was higher in people with high homocysteine levels than in people with normal levels. Based on selected studies, increased homocysteine levels in men and women increases the risk of ischemic stroke. Because homocysteine levels are a modifiable risk factor, diet and prevention of vitamin B12 decrease can help prevent an increased risk of ischemic stroke.
- Homocysteine
- ischemic stroke
- systematic review
How to Cite
References
Fricker M, Tolkovsky AM, Borutaite V, Coleman M, Brown GC. Neuronal Cell Death. Physiol Rev. 2018;98(2):813-80.
Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Rev Neurol (Paris). 2016;172(1):59-68.
Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin. 2008;26(4):871-95, vii.
Randolph SA. Ischemic Stroke. Workplace Health Saf. 2016;64(9):444.
Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-95.
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-236.
Allen CL, Bayraktutan U. Risk factors for ischaemic stroke. Int J Stroke. 2008;3(2):105-16.
Harris S, Kurniawan M, Rasyid A, Mesiano T, Hidayat R. Cerebral small vessel disease in Indonesia: Lacunar infarction study from Indonesian Stroke Registry 2012-2014. SAGE Open Med. 2018;6:2050312118784312.
Jackson C, Sudlow C. Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke. 2005;36(4):891-901.
Sen U, Tyagi SC. Homocysteine and Hypertension in Diabetes: Does PPARgamma Have a Regulatory Role? PPAR Res. 2010;2010:806538.Humphrey LL, Fu R, Rogers K, et al. Homocysteine level and coronary heart disease incidence: a systematic review and metaanalysis. Mayo Clin Proc. 2008;83:1203–12.
Wang C, Han L, Wu Q, Zhuo R, Liu K, Zhao J, et al. Association between homocysteine and incidence of ischemic stroke in subjects with essential hypertension: a matched case-control study. Clin Exp Hypertens. 2015;37(7):557-62.
Li J, Wang Y, Li H, Zuo Z, Lin J, Wang A, et al. Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack: Subanalysis of the CHANCE Trial. Arterioscler Thromb Vasc Biol. 2020;40(3):839-46.
Hultdin J, Van Guelpen B, Winkvist A, Hallmans G, Weinehall L, Stegmayr B, et al. Prospective study of first stroke in relation to plasma homocysteine and MTHFR 677C>T and 1298A>C genotypes and haplotypes - evidence for an association with hemorrhagic stroke. Clin Chem Lab Med. 2011;49(9):1555-62.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Pratoomsoot C, Sruamsiri R, Dilokthornsakul P, Chaiyakunapruk N. Quality of reporting of randomised controlled trials of herbal interventions in ASEAN Plus Six Countries: a systematic review. PLoS One. 2015;10(1):e108681.
Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-s4.
Han L, Wu Q, Wang C, Hao Y, Zhao J, Zhang L, et al. Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients: A Population-Based, Prospective Cohort Study. Stroke. 2015;46(7):1777-86.
Choi SH, Choi-Kwon S, Kim MS, Kim JS. Poor nutrition and alcohol consumption are related to high serum homocysteine level at post-stroke. Nutr Res Pract. 2015;9(5):503-10.
Wang CY, Chen ZW, Zhang T, Liu J, Chen SH, Liu SY, et al. Elevated plasma homocysteine level is associated with ischemic stroke in Chinese hypertensive patients. Eur J Intern Med. 2014;25(6):538-44.
Cui R, Moriyama Y, Koike KA, Date C, Kikuchi S, Tamakoshi A, et al. Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese: The JACC study. Atherosclerosis. 2008;198(2):412-8.
Angelova EA, Atanassova PA, Chalakova NT, Dimitrov BD. Associations between serum selenium and total plasma homocysteine during the acute phase of ischaemic stroke. Eur Neurol. 2008;60(6):298-303.
Bos MJ, van Goor ML, Koudstaal PJ, Dippel DW. Plasma homocysteine is a risk factor for recurrent vascular events in young patients with an ischaemic stroke or TIA. J Neurol. 2005;252(3):332-7.
Donkor ES. Stroke in the 21(st) Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165.
Bushnell CD, Goldstein LB. Homocysteine testing in patients with acute ischemic stroke. Neurology. 2002;59(10):1541-6.
Pezzini A, Grassi M, Del Zotto E, Assanelli D, Archetti S, Negrini R, et al. Interaction of homocysteine and conventional predisposing factors on risk of ischaemic stroke in young people: consistency in phenotype-disease analysis and genotype-disease analysis. J Neurol Neurosurg Psychiatry. 2006;77(10):1150-6.
Marcus J, Sarnak MJ, Menon V. Homocysteine lowering and cardiovascular disease risk: lost in translation. Can J Cardiol. 2007;23(9):707-10.
Liu L, Teng J, Ma M, Guo L, Yang L, Gao J, et al. Serum homocysteine level is an independent predictor for hemorrhagic transformation within 24 h of intravenous thrombolysis in acute ischemic stroke. J Clin Neurosci. 2020;82(Pt A):13-9.
Boysen G, Brander T, Christensen H, Gideon R, Truelsen T. Homocysteine and risk of recurrent stroke. Stroke. 2003;34(5):1258-61.
Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88.
Shi Z, Guan Y, Huo YR, Liu S, Zhang M, Lu H, et al. Elevated Total Homocysteine Levels in Acute Ischemic Stroke Are Associated With Long-Term Mortality. Stroke. 2015;46(9):2419-25.
Caso V, Paciaroni M. MTHFR 677 TT genotype and hyperhomocysteinaemia: an underestimated risk TANDEM for patients with stroke. J Neurol Neurosurg Psychiatry. 2006;77(10):1103.
Virtanen JK, Voutilainen S, Happonen P, Alfthan G, Kaikkonen J, Mursu J, et al. Serum homocysteine, folate and risk of stroke: Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. Eur J Cardiovasc Prev Rehabil. 2005;12(4):369-75.
Wang Y, Dai Y, Zheng J, Xie Y, Guo R, Guo X, et al. Sex difference in the incidence of stroke and its corresponding influence factors: results from a follow-up 8.4 years of rural China hypertensive prospective cohort study. Lipids Health Dis. 2019;18(1):72.
Pisu M, Richman JS, Martin RC, Kim Y, Kratt P, Clements K, et al. Diagnostic tests and neurology care for Medicare beneficiaries with seizures: differences across racial groups. Med Care. 2012;50(8):730-6.
Bigi S, Fischer U, Wehrli E, Mattle HP, Boltshauser E, Bürki S, et al. Acute ischemic stroke in children versus young adults. Ann Neurol. 2011;70(2):245-54.
Hart RG, Miller VT. Cerebral infarction in young adults: a practical approach. Stroke. 1983;14(1):110-4.
Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-58.
Spence JD. Homocysteine lowering for stroke prevention: Unravelling the complexity of the evidence. Int J Stroke. 2016;11(7):744-7.
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