Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Neurology

Background:

• Hyperhomocysteinemia (HHcy) is linked to vascular disease.
• The role of HHcy in recurrent vascular events among stroke patients, particularly those with chronic kidney disease (CKD), requires further investigation.

Purpose of the Study:

• To evaluate the prognostic significance of HHcy on the risk of recurrent vascular events in patients following ischemic stroke or transient ischemic attack.
• To determine if the presence of CKD modifies the association between HHcy and adverse vascular outcomes.

Main Methods:

• A prospective observational study involving 621 patients with recent ischemic stroke or transient ischemic attack.
• Patients were followed for 1 year, with HHcy defined as total homocysteine >15 µmol/L and CKD as eGFR <60 mL/min/1.73 m² or renal replacement therapy.
• The primary outcome was a composite of major adverse cardiovascular events (MACE), including stroke, acute coronary syndrome, peripheral artery disease, and vascular death.

Main Results:

• The prevalence of HHcy was 18.5%. Patients with HHcy had higher rates of intracranial and extracranial artery stenosis.
• At 1 year, HHcy was associated with a significantly higher risk of MACE (17.8% vs. 10.4%).
• In Cox models, HHcy was an independent predictor of MACE in patients with CKD (aHR, 2.06; 95% CI, 1.02-4.20) but not in those without CKD (aHR, 1.00; 95% CI, 0.30-3.32).

Conclusions:

• Elevated serum homocysteine is a significant, independent risk factor for recurrent vascular events in stroke patients with CKD.
• HHcy does not appear to be a significant predictor of recurrent vascular events in stroke patients without CKD.
• Targeting HHcy may be a modifiable risk factor strategy for stroke patients with co-existing CKD.