DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181433

Study of serum homocysteine level in cases of non-diabetic ischemic stroke

Malati Murmu, Karun Mahesh K. P., Sanjay Dash, Lagendra Kumar Singh, Ayaskanta Kar, Pravin Kumar Mishra

Abstract


Background: Aim of the study was to measure serum homocysteine levels in non-diabetic ischemic stroke and to co-relate its significance with other risk factors of ischemic stroke. It was a case control study.

Methods: The study was done in the Department of Medicine, VSS.I.M.S.A.R, Burla, Odisha. 42 patients of non-diabetic ischemic and 42 age and sex matched controls were included in the study. Adults above the age of 18 years who were non-diabetic presenting with first-ever ischemic stroke, confirmed by CT scan of brain were included. Diabetic patients, haemorrhagic stroke, suspected embolic stroke, patients on vitamin supplementations, chronic usage of phenytoin were excluded. Routine investigations, fasting serum lipid profile and serum homocysteine levels were done.

Results: Mean serum homocysteine level in ischemic stroke patients were found to be much higher (25.83 micro mol/L) in comparison to control group (9.77 micro mol/L) which is statistically significant. Mean serum homocysteine levels were found to be higher in patients with age group of more than 60 years, male sex, sedentary lifestyle, vegetarian diet, hypertensive patients and patient with normal fasting lipid profile. Statistical analysis for significance of difference was done using Chi-Square test with Yate’s correction.

Conclusions: A statistically significant correlation was found between all the studied risk factors among non-diabetic patients and serum homocysteine levels. Estimation of serum homocysteine is advisable in all cases of non-diabetic ischemic strokes to know the prognosis.


Keywords


Homocysteine, Ischemic stroke, Non-diabetic, Risk factors

Full Text:

PDF

References


Smith WS, Johnston SC, Hemphill III JC. Cerebrovascular Diseases. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J eds. Harrison’s Principle of Internal Medicine. 19th Ed. McGraw Hill; 2015:2559-2586.

Musuka TD, Wilton SB, Traboulsi M, Hill MD. Diagnosis and management of acute ischemic stroke: speed is critical. Canadian Medical Association Journal. 2015 Sep 8;187(12):887-93.

Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence‐based causative classification system for acute ischemic stroke. Annals of neurology. 2005 Nov 1;58(5):688-97.

Kanjwal MK, Cooper C, Bashir R. Peripheral arterial disease-the silent killer. JK-Practitioner. 2004;11(4):225-32.

Fonseca V, Desouza C, Asnani S, Jialal I. Nontraditional risk factors for cardiovascular disease in diabetes. Endocrine reviews. 2004 Feb 1;25(1):153-75.

Jacobsen DW, Gatautis VJ, Green R, Robinson K, Savon SR, Secic M, et al. Rapid HPLC determination of total homocysteine and other thiols in serum and plasma: sex differences and correlation with cobalamin and folate concentrations in healthy subjects. Clinical chemistry. 1994;40(6):873-81.

Seshadri S, Beiser A, Selhub J, Jacques PF, Rosenberg IH, D'agostino RB, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. New England Journal of Medicine. 2002 Feb 14;346(7):476-83.

Haynes WG. Hyperhomocysteinemia, vascular function and atherosclerosis: effects of vitamins. Cardiovascular Drugs and therapy. 2002 Sep 1;16(5):391-9.

den Heijer T, Vermeer SE, Clarke R, Oudkerk M, Koudstaal PJ, Hofman A, et al. Homocysteine and brain atrophy on MRI of non‐demented elderly. Brain. 2002 Jan 1;126(1):170-5.

Graham IM, Daly LE, Refsum HM, Robinson K, Brattström LE, Ueland PM, et al. Plasma homocysteine as a risk factor for vascular disease: the European Concerted Action Project. Jama. 1997 Jun 11;277(22):1775-81.

Mojiminiyi OA, Marouf R, Al Shayeb AR, Qurtom M, Abdella NA, Al Wazzan H et al. Determinants and associations of homocysteine and prothrombotic risk factors in Kuwaiti patients with cerebrovascular accident. Medical Principles and Practice. 2008;17(2):136-42.

Chico A, Perez A, Cordoba A, Arcelus R, Carreras G, De Leiva A et al. Plasma homocysteine is related to albumin excretion rate in patients with diabetes mellitus: a new link between diabetic nephropathy and cardiovascular disease?. Diabetologia. 1998 May 1;41(6):684-93.

Datta S, Pal SK, Mazumdar H, Bhandari B, Bhattacherjee S, Pandit S. Homocysteine and cerebrovascular accidents. Journal of the Indian Medical Association. 2009 Jun;107(6):345-6.

Boysen G, Brander T, Christensen H, Gideon R, Truelsen T. Homocysteine and risk of recurrent stroke. stroke. 2003 May 1;34(5):1258-61.

Modi M, Prabhakar S, Majumdar S, Khullar M, Lal V, Das CP. Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario. Neurology India. 2005 Jul 1;53(3):297.

Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. Jama. 2002 Oct 23;288(16):2015-22.

Zongte Z, Shaini L, Debbarma A, Singh TB, Devi SB, Singh WG. Serum homocysteine levels in cerebrovascular accidents. Indian journal of clinical biochemistry. 2008 Apr 1;23(2):154-7.

Narang AP, Verma I, Kaur S, Narang A, Gupta S, Avasthi G. Homocysteine–Risk factor for ischemic stroke.

Bogdan NM, Eliza O, Ileana CF. Homocysteine and vitamin therapy in stroke prevention and treatment: a review. Acta Biochimica Polonica 2010;57(4):467-77.

Kang SS, Zhou J, Wong PW, Kowalisyn J, Strokosch G. Intermediate homocysteinemia: a thermolabile variant of methylenetetrahydrofolate reductase. American journal of human genetics. 1988 Oct;43(4):414.

Perry IJ. Homocysteine, hypertension and stroke. Journal of human hypertension. 1999 May;13(5):289.

Appel LJ, Miller ER, Jee SH, Stolzenberg-Solomon R, Lin PH, et al. Effect of dietary patterns on serum homocysteine: results of a randomized, controlled feeding study. Circulation. 2000 Aug 22;102(8):852-7.

Yakub M, Iqbal MP, Kakepoto GN, Rafique G, Memon Y, Azam I, et al. High prevalence of mild hyperhomocysteinemia and folate, B 12 and B 6 deficiencies in an urban population in Karachi, Pakistan. Pakistan Journal of Medical Sciences. 2010 Oct 1;26(4).

Spengos K, Vemmos K. Risk factors, etiology, and outcome of first‐ever ischemic stroke in young adults aged 15 to 45–the Athens young stroke registry. European journal of neurology. 2010 Nov 1;17(11):1358-64.

Kittner SJ. Stroke in the young Coming of age. Neurology. 2002 Jul 9;59(1):6-7.

Graham IM, Daly LE, Refsum HM, Robinson K, Brattström LE, Ueland PM et al. Plasma homocysteine as a risk factor for vascular disease: the European Concerted Action Project. Jama. 1997 Jun 11;277(22):1775-81.