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Ischemic stroke and hyperhomocysteinemia: truth or myth?

A Terwecoren1, E Steen, D Benoit

  • 1Department of Neurology, Ghent University, Ghent, Belgium. Annelies.Terwecoren@Ugent.be

Acta Neurologica Belgica
|November 12, 2009
PubMed

Insights

High homocysteine levels (hyperhomocysteinemia) are linked to stroke risk, though a direct cause isn't confirmed. Testing and vitamin B treatment are recommended for certain stroke patients, but long-term benefits need more study.

Area of Science:

  • Cardiovascular Science
  • Neurology
  • Metabolic Disorders

Background:

  • Hyperhomocysteinemia, an elevation of homocysteine in the blood, is recognized as a potential risk factor for atherothrombotic diseases.
  • The condition arises from disruptions in the methionine-homocysteine metabolism, involving enzyme deficiencies, vitamin shortfalls, and other contributing elements.

Observation:

  • Observational studies, genetic analyses, and meta-analyses suggest a causal link between homocysteine levels and cerebrovascular diseases.
  • Elevated homocysteine warrants investigation in patients with unexplained vascular disease or thrombosis, young ischemic stroke patients, and those with a family history of early atherosclerosis.

Findings:

  • While a definitive causal relationship between hyperhomocysteinemia and atherothrombotic diseases is still under investigation, evidence implicates homocysteine in cerebrovascular conditions.
  • Current guidelines recommend testing homocysteine levels in specific stroke patient groups.

Implications:

  • The American Heart and Stroke Association suggests daily supplementation with folic acid, vitamin B12, and vitamin B6 for stroke patients with hyperhomocysteinemia due to the therapy's low cost and safety.
  • However, conclusive evidence demonstrating significant benefits in secondary stroke prevention is pending further large-scale trial results.

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