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Titolo:
Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke
Autore:
Eikelboom, JW; Hankey, GJ; Anand, SS; Lofthouse, E; Staples, N; Baker, RI;
Indirizzi:
Royal Perth Hosp, Dept Neurol, Stroke Unit, Perth, WA 6001, Australia Royal Perth Hosp Perth WA Australia 6001 Unit, Perth, WA 6001, Australia McMaster Univ, Prevent Cardiol & Therapeut Program, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada Therapeut Program, Hamilton, ON, Canada McMaster Univ, Dept Med, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada er Univ, Dept Med, Hamilton, ON, Canada Royal Perth Hosp, Dept Hematol, Clin Thrombosis Unit, Perth, WA, AustraliaRoyal Perth Hosp Perth WA Australia hrombosis Unit, Perth, WA, Australia
Titolo Testata:
STROKE
fascicolo: 5, volume: 31, anno: 2000,
pagine: 1069 - 1075
SICI:
0039-2499(200005)31:5<1069:ABHHAI>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
METHYLENETETRAHYDROFOLATE REDUCTASE GENE; PLASMA HOMOCYST(E)INE; VASCULAR-DISEASE; RISK-FACTORS; MYOCARDIAL-INFARCTION; COMMON MUTATION; GLOBAL BURDEN; HOMOCYSTEINE; FOLATE; MORTALITY;
Keywords:
arterial occlusive disease; homocyst(e)ine; ischemic risk; stroke;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Hankey, GJ Royal Perth Hosp, Dept Neurol, Stroke Unit, POB X2213,Wellington St, Perth, WA 6001, Australia Royal Perth Hosp POB X2213,Wellington St Perth WA Australia 6001
Citazione:
J.W. Eikelboom et al., "Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke", STROKE, 31(5), 2000, pp. 1069-1075

Abstract

Background and Purpose-Elevated plasma homocyst(e)ine may be a causal and modifiable risk factor for ischemic stroke, but the results of previous studies have been conflicting. One possible explanation is that homocyst(e)inemay only be associated with certain pathophysiological subtypes of ischemic stroke. Methods-We conducted a case-control study of 219 hospital cases with a first-ever ischemic stroke and 205 randomly selected community control subjects stratified by age, sex, and postal code. With the use of established criteria, cases of stroke were classified by etiologic subtype in a blinded fashion. The prevalence of conventional vascular risk factors, fasting plasma homocyst(e)ine levels, vitamin levels, and nucleotide 677 methylene tetrahydrofolate reductase (MTHFR) genotypes were determined in cases and controls. Results-Increasing homocyst(e)ine was a strong and independent risk factorfor ischemic stroke (adjusted OR 2.7, 95% CI 1.4 to 5.1 for a 5-mu mol/L increase in fasting plasma homocyst(e)ine from 10 to 15 mu mol/L). Compared with the lowest quartile, the highest quartile of homocyst(e)ine was associated with an adjusted OR of ischemic stroke of 2.2 (95% CI 1.1 to 4.2), Mean plasma homocyst(e)ine was significantly higher in cases of ischemic stroke due to large-artery disease (14.1 mu mol/L, 95% CI 12.5 to 15.9, P<0.001)and small-artery disease (12.7 mu mol/L, 95% CI 11.4 to 14.1, P=0.004) compared with control subjects (10.5 mu mol/L; 95% CI 10.0 to 11.0) but not incardioembolic or other etiologic subtypes of ischemic stroke. Compared with the lowest quartile of homocyst(e)ine, the upper 3 quartiles were associated with an adjusted OR of ischemic stroke due to large-artery disease of 3.0 (95% CI 0.8 to 10.8) for the second quartile, 5.6 (95% CI 1.6 to 20) forthe third quartile, and 8.7 (95% CI 2.4 to 32) for the fourth quartile (P for trend=0.0005). However, despite a clear association between the TT MTHFR genotype and elevated fasting plasma homocyst(e)ine. there was no association between MTHFR genotype and ischemic stroke or subtype of ischemic stroke. Conclusions-There is a strong, graded association between increasing plasma homocyst(e)ine and ischemic stroke caused by large-artery atherosclerosisand, to a much lesser extent, small-artery disease, but not cardioembolic or other etiologic subtypes of ischemic stroke. Our results are consistent with the hypothesis that the deleterious effect of high homocyst(e)ine is mediated primarily via a proatherogenic effect.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/09/20 alle ore 12:08:34