KITAGAWA KAZUO    Department   Other, Other    Position
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