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Homocysteine, Carotid Intima Media Thickness and NIHSS Score: Clinical Relevance in Indian Stroke Patients
Vatsal Navin Jain1, Priyanka Rana2, Kshitij Arun Bhoge1
1Rajiv Gandhi Medical College & Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane, India.
Insights
High homocysteine (HCY) levels predict stroke severity and are linked to increased carotid artery thickness. Measuring intima-media thickness (IMT) may help predict HCY levels, potentially streamlining stroke management.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Biochemistry
Background:
- Stroke is a leading cause of death and disability globally.
- Elevated homocysteine (HCY) is a potential risk factor for cerebrovascular disease.
- Carotid intima-media thickness (IMT) is an indicator of atherosclerosis.
Purpose of the Study:
- To evaluate the role of homocysteine (HCY) in stroke.
- To assess the relationship between HCY levels and stroke severity.
- To investigate the association between HCY and carotid intima-media thickness (IMT).
Main Methods:
- Recruited 78 patients with acute ischemic stroke.
- Assessed stroke severity using the National Institutes of Health Stroke Scale (NIHSS).
- Measured serum HCY, fasting blood glucose, lipid profile, and carotid IMT (CCA and ICA).
Main Results:
- 71.93% of patients were hyperhomocysteinemic (HHcyc).
- HHcyc was associated with increased internal carotid artery (ICA) IMT.
- ICA IMT positively correlated with HCY levels (P=0.012) and predicted HHcyc state with high sensitivity.
Conclusions:
- Hyperhomocysteinemia (HHcyc) predicts stroke severity.
- ICA IMT measurement can predict elevated HCY levels, potentially reducing the need for HCY testing.
- Routine evaluation of HCY and ICA IMT is suggested for stroke management.
Background:
Stroke is one of the leading causes of mortality and morbidity worldwide accounting for 85% of global deaths from stroke. This study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters and it's with carotid intima-media thickness (IMT).
Methods:
78 patients of radiology-confirmed acute ischemic stroke were recruited for this study and National Institutes of Health Stroke Scale (NIHSS) score was evaluated upon admission. Blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of neck ascertained IMT of Common (CCA) and internal carotid artery (ICA).
Results:
Average age of male and female subjects was 57.88 ± 13.97 & 59.16 ± 13.62 years respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc) and 24.36% were hyperlipidemic. Patients with NIHSS ≥ 5 had higher low-density lipoprotein cholesterol (LDLC) than those with NIHSS < 5. HCY cutoff of ≥ 15 μmol/L had 91.7% sensitivity & 66.7% specificity for predicting. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT with which it is positively correlated (P-Value = 0.012).
Conclusion:
HHcyc state holds a good predictive value for severity of stroke. We also came to a conclusion that ICA IMT measurement may also reduce the need for a homocysteine test as it predicts higher HCY levels; this will reduce the burden on resources. We suggest that evaluating HCY and ICA IMT should be made part of the standard protocol for management of stroke.
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