Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease.
J Atheroscler Thromb
; 30(9): 1198-1209, 2023 Sep 01.
Article
em En
| MEDLINE
| ID: mdl-36436876
ABSTRACT
AIMS:
We aimed to assess the prognostic impact of hyperhomocysteinemia (HHcy) on the recurrent vascular event risk in stroke patients with or without chronic kidney disease (CKD).METHODS:
In this prospective observational study, 621 patients (mean age, 69.5 years; male, 62.2%) with ischemic stroke or transient ischemic attack were consecutively enrolled within 1 week of onset and followed-up for 1 year. HHcy was defined as elevated levels of fasting total homocysteine ï¼15 µmol/L. CKD was defined as an estimated glomerular filtration rate of ï¼60 mL/min/1.73 m2 or a history of renal replacement therapy. The primary outcome was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death.RESULTS:
The prevalence of HHcy was 18.5%. Patients with HHcy were more likely to have intracranial (37.4% versus 24.8%; p=0.008) and extracranial (20.9% versus 13.0%; p=0.037) artery stenosis than were those without HHcy. At 1 year, patients with HHcy were at a greater risk of MACE than were those without HHcy (annual rate, 17.8% versus 10.4%; log-rank p=0.033). In the Cox proportional hazard regression models, HHcy was independently associated with an increased risk of MACE in patients with CKD (adjusted hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.02-4.20), whereas HHcy was not predictive of MACE in those without CKD (adjusted HR, 1.00; 95% CI, 0.30-3.32).CONCLUSIONS:
Elevated levels of serum homocysteine can be an important modifiable risk factor in stroke patients with CKD, but not in those without CKD.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Ataque Isquêmico Transitório
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Hiper-Homocisteinemia
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Acidente Vascular Cerebral
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Insuficiência Renal Crônica
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article