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Published on: September 26, 2018
Blood Levels of Homocysteine Predict Cardiovascular Events, but Not Alzheimer Disease Dementia, during a 4.7-year
Kazuo Kitagawa1,2, Sono Toi1,3, Hiroshi Yoshizawa1,4
1Department of Neurology, Tokyo Women's Medical University Hospital, Japan.
Insights
High homocysteine levels strongly predict vascular events like stroke and MACE. However, this study found no link between homocysteine and Alzheimer's disease (AD) dementia risk.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Biochemistry
Background:
- Elevated homocysteine is a known risk factor for vascular events and dementia.
- The comparative predictive value of homocysteine for vascular events versus Alzheimer's disease (AD) dementia is not well-established.
Purpose of the Study:
- To compare the predictive utility of serum homocysteine levels for vascular events and AD dementia within the same patient cohort.
- To investigate the association between homocysteine levels and the risk of stroke, major cardiovascular events (MACE), and AD dementia.
Main Methods:
- A Japanese hospital-based cohort study followed 426 patients with vascular risk factors for a median of 4.65 years.
- Patients were stratified by homocysteine levels into tertiles and high/low groups (cut-off 15.0 nmol/L).
- Outcomes assessed included stroke, MACE, and AD dementia incidence.
Main Results:
- Higher homocysteine levels (3rd tertile and >15.0 nmol/L) were significantly associated with increased risk of incident stroke (HR 3.59) and MACE (HR 5.19) after adjusting for confounders.
- No significant association was found between homocysteine levels and the risk of AD dementia.
- Stroke, MACE, and AD dementia occurred in 23, 31, and 15 patients, respectively.
Conclusions:
- High serum homocysteine levels, particularly exceeding 15.0 nmol/L, are significant predictors of vascular events.
- Serum homocysteine levels do not appear to be associated with an increased risk of AD dementia in this cohort.
- These findings highlight the importance of homocysteine in vascular risk stratification but not for predicting Alzheimer's disease.
Abstract:
Objective The homocysteine levels are risk factors for vascular events and dementia. However, whether their predictive validity is similar remains unknown. We compared the utility of the homocysteine levels for predicting vascular events and Alzheimer's disease (AD) and dementia in the same population. Methods This study was a Japanese hospital-based cohort study. A total of 426 patients with vascular risk factors were followed for a median of 4.65 years. Based on the homocysteine levels, patients were divided into three groups: 1st tertile (≤8.2 nmol/L, n=141), 2nd tertile (8.3-10.9 nmol/L, n=141), and 3rd tertile (≥11.0 nmol/L, n=144). They were also divided with the cut-off value of 15.0 nmol/L into high (n=55) and low (n=371) groups. The outcomes were stroke, major cardiovascular events (MACE), and AD dementia. Results During follow-up, stroke, MACE, and AD dementia occurred in 23, 31, and 15 patients, respectively. Patients in the 3rd tertile and high groups were more likely to have incident stroke and MACE than those in the other tertiles or low group. Patients with high homocysteine levels had a higher risk of stroke (hazard ratio 3.59; 95% confidence interval 1.09-11.83) and MACE (hazard ratio 5.19; 95% confidence interval 1.90-14.15) than those with low homocysteine levels after adjustment for confounding factors. However, no association was observed between the homocysteine levels and AD. Conclusion High serum homocysteine levels, especially more than 15.0 nmol/L, were significantly associated with vascular events but not with AD dementia in the same population during a 4.65-year follow-up period.
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