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Hyperhomocysteinemia is Associated with Aortic Atheroma Progression in Stroke/TIA Patients

Souvik Sen1, P Leema Reddy, Raji P Grewal

  • 1Department of Neurology, University of South Carolina School of Medicine Columbia, SC, USA.

Frontiers in Neurology
|December 29, 2010
PubMed

Insights

Elevated total homocysteine levels (tHcy) are linked to aortic arch atheroma progression in stroke patients. This study confirms a significant association between higher tHcy and increased risk of aortic arch plaque advancement over one year.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Atherosclerosis Research

Background:

  • Aortic arch (AA) atheroma and its progression are established risk factors for recurrent vascular events in patients with stroke or transient ischemic attack (TIA).
  • Elevated total homocysteine (tHcy) levels are recognized as an independent risk marker for atherosclerosis, including within the aortic arch.

Purpose of the Study:

  • To prospectively investigate the association between the progression of aortic arch atheroma and total homocysteine levels in stroke/TIA patients.

Main Methods:

  • A cohort study involving 118 stroke/TIA patients with measurable AA atheroma and available tHcy data.
  • Follow-up transesophageal echocardiograms (TEE) were performed at 12 months to assess AA atheroma progression (defined as ≥1 grade increase).
  • Evaluations included vascular risk factors, dietary intake (folate, B12, pyridoxine), and MTHFR polymorphism.

Main Results:

  • A significant association was found between elevated tHcy (≥14.0 μmol/l) and AA atheroma progression (univariate RR=3.4, adjusted RR=3.6).
  • Changes in AA plaque thickness and area correlated with tHcy levels.
  • tHcy independently predicted changes in plaque thickness over 12 months, irrespective of other factors.

Conclusions:

  • The study validates a significant association between total homocysteine levels and the progression of aortic arch atheroma.
  • A linear correlation exists between tHcy and the advancement of AA atheroma, highlighting tHcy as a key marker.
Abstract

Keywords:
aortacardiac embolismcerebrovascular diseasehomocysteinestroke

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