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キタガワ カズオ
Kitagawa Kazuo
北川 一夫 所属 医学部 医学科（東京女子医科大学病院） 職種 非常勤嘱託 |
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| 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 |