ISHIZUKA KENTARO
Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position |
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Article types | Original article |
Language | English |
Peer review | Peer reviewed |
Title | Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease. |
Journal | Formal name:Journal of atherosclerosis and thrombosis Abbreviation:J Atheroscler Thromb ISSN code:18803873/13403478 |
Domestic / Foregin | Foregin |
Volume, Issue, Page | pp.Online ahead of print |
Author and coauthor | Mizuno Takafumi†, Hoshino Takao*, Ishizuka Kentaro, Toi Sono, Takahashi Shuntaro, Wako Sho, Arai Satoko, Kitagawa Kazuo |
Publication date | 2022/11 |
Summary | 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 |