イシヅカ　ケンタロウ   Ishidzuka Kentarou   石塚　健太郎    所属   医学部 医学科（東京女子医科大学病院）    職種   非常勤講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease.
掲載誌名	正式名：Journal of atherosclerosis and thrombosis 略　 称：J Atheroscler Thromb ISSNコード：18803873/13403478
掲載区分	国外
巻・号・頁	pp.Online ahead of print
著者・共著者	Mizuno Takafumi†, Hoshino Takao*, Ishizuka Kentaro, Toi Sono, Takahashi Shuntaro, Wako Sho, Arai Satoko, Kitagawa Kazuo
発行年月	2022/11
概要	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 ＞15 µmol/L. CKD was defined as an estimated glomerular filtration rate of ＜60 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.
DOI	10.5551/jat.63849
PMID	36436876