Several casecontrol studies and even a metaanalysis have confirmed a link between venous thrombosis and hyperhomocysteinemia. Grewal3, marjorie busby4, patricia chang 4 and alan hinderliter 1 department of neurology, university of south carolina school of medicine, columbia, sc, usa 2 the neurogenetics foundation, cranbury, nj, usa. J mk murthy department of neurology, the institute of neurological sciences, care hospital, hyderabad 500 001 india. The diagnosis of cerebral venous thrombosis is easier nowadays due to easy access to advanced neuroimaging techniques. Hyperhomocysteinemia as a risk factor for ischemic stroke. Frequency of homocysteinemia in young ischemic stroke. The treatment of mild hyperhomocysteinemia is based on the hypothesis that the nutritional status of the micronutrients that drive homocysteine metabolism, folate, b 12, and b 6, is suboptimal and that by dietary supplementation with folic acid, cyanocobalamin vitamin b 12, and pyridoxine hydrochloride vitamin b 6, either singly or in. Hyperhomocysteinemia, obesity and cryptogenic stroke ios. Hyperhomocysteinemia is a disorder associated with derangements of the metabolic pathway involved in metabolism of the essential amino acid methionine. This study was conducted to investigate the role of different homocysteine metabolismrelated vitamin hmrv levels in the correlation between hyperhomocysteinemia hhcy and ischemic stroke is subtypes. Hyperhomocysteinemia is one of the risk factors associated with cerebrovascular stiffness in hypertensive patients, especially elderly males takafumi okura 1 kenichi miyoshi 1. Homocysteine as a risk factor in stroke slideshare. Hyperhomocysteinemia, ischemic stroke, and bvitamin. It is more common in young adults with women affected more than men.
To study homocysteine levels in patients with ischemic stroke and compare it with age and sexmatched controls. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Venous thromboembolism and hyperhomocysteinemia as first. At ruby hall study the homocysteine falls in stroke patients after treatment reached 30. Hyperhomocysteinemia is generally acknowledged as a treatable risk factor for atherotrombotic diseases, but a causal relationship between both is not yet definitively established. We investigated the factors associated with increased levels of homocysteine hcy and the relationship between hhcy and motor symptoms, cognitive status, and vascular risk in patients with parkinsons disease. An uncommon presentation of hyperhomocysteinemia and. Pdf hyperhomocysteinemia is generally acknowledged as a treatable risk factor for atherotrombotic diseases, but a causal relationship between both is. Hyperhomocysteinemia and vitamin b12 deficiency in.
Hyperhomocysteinemia, oxidative stress, and cerebral. Hyperhomocysteinemia as the cause for familial thrombophilia and atherosclerosis 8 sheikha. Stroke is the leading cause of mortality and disability in china and the second leading cause of death in the world. The aim of this collaborative metaanalysis was to combine individual participant data from all relevant observational studies to produce reliable estimates of the associations of total plasma homocysteine with ischemic heart disease ihd and stroke, with adjustment for confounding caused by known cardiovascular risk factors and correction for. Homocysteine and vitamins in cardiovascular disease. The mean plasma homocysteine level of the stroke patients was. Homocystinuria homocystinuria is a disorder of methionine metabolism, leading to an abnormal accumulation of homocysteine and its metabolites homocystine, homocysteinecysteine complex, and others in blood and urine. Hyperhomocysteinemia originates from a deviation in the methioninehomocysteine metabolism including disturbances of enzymes, vitamin deficiencies and different other factors. The effect of hyperhomocysteinemia on motor symptoms. Hyperhomocysteinemia and its implications in atherosclerosis ppt copy 2 copy 1. Mild hyperhomocysteinemia is an established risk factor for atherosclerosis and vascular disease. Hyperhomocysteinemia and strokethe ruby hall study. Hyperhomocysteinemia in patients with acute ischaemic. Homocysteine new studies raised homocysteine levels are seen in sufferers of chronic fatigue syndrome cfs homocysteine accelerates the aging process by shortening telomeres.
Frequency of homocysteinemia in young ischemic stroke patients. Pdf relationship between homocysteine and ischemic stroke. Severity of symptoms is determined by how high the homocysteine levels are. Hyperhomocysteinemia is an emerging risk factor for cardiovascular disease and stroke. The prevalence of mild hyperhomocysteinemia was 23% 12. Homocysteine and risk of ischemic heart disease and stroke. The identification of homocysteine as a risk factor for cad and stroke carries important public health implications. Ppt homocystinuria powerpoint presentation free to.
Hyperhomocysteinemia as a risk factor for deepvein. Normally, these metabolites are not found in appreciable quantities in blood or urine. Hyperhomocysteinemia, a new independent risk factor for atherosclerotic vascular disease, has been described in the last ten years. Hyperhomocysteinemia, alone or with other thrombophilic risk 46 factors, may be associated with vascular occlusive pathology underlying varied clinical 47 presentations. Homocysteine and its relationship to stroke subtypes in a uk black. Of the 9522 patients with stroke, 307 27% with hyperhomocysteinemia hhcy had recurrent stroke. Hyperhomocysteinemia an overview sciencedirect topics. It is often associated with folate or cobalamin deficiency as well as genetic defects. Homocysteine hcy is a toxic, sulfurcontaining intermediate of methionine metabolism. The aims of our study were to assess i the association between risk of stroke and increasing values of plasma homocysteine and ii the interaction between mild hyperhomocysteinemia and conventional vascular risk factors. Homocysteine is an intermediary amino acid formed by the conversion of methionine to cysteine figure 1. Hyperhomocysteinemia hematology and oncology merck. The levels of homocysteine did not correlate with early stroke outcome.
Clinical manifestations of homocystinuria include developmental delay, marfanoid appearance. Hyperhomocysteinemia, endothelial dysfunction, and. Hyperhomocysteinemia is associated with aortic atheroma progression in stroke tia patients souvik sen1, p. First, 9238 randomly selected whites from the general population were followed for 23 years. Homocysteine as a risk factor for vascular disease. We tested the hypothesis that methylenetetrahydrofolate reductase mthfr c677t homozygosity with hyperhomocysteinemia is associated with icd and vte.
Association of hyperhomocysteinemia with stroke recurrence after. One potential mechanism for decreased nitric oxide bioavailability is. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Murthy department of neurology, the institute of neurological sciences, care hospital, hyderabad, india ischemic stroke has a high prevalence and high burden of illness. Three hundred and fortyeight is patients manifesting different vascular subtypes were subclassified on the basis of hmrv deficiencies.
Hyperhomocysteinemia may predispose to arterial thrombosis and venous thromboembolism by injuring vascular endothelial cells. Hyperhomocysteinemia, ischemic stroke, and bvitamin treatment. All statistical tests were performed using spss version 15. Association between hyperhomocysteinemia and stroke with. The role of hyperhomocysteinemia as independent risk factor for stroke needs to be confirmed. Hyperhomocysteinemia is associated with aortic atheroma. Hyperhomocysteinemia has been suspected of favoring thrombosis. Cerebral venous thrombosis is relatively rare and characterized by a wide spectrum of clinical features. Hyperhomocysteinemia and its implications in atherosclerosis ppt c. We aimed to determine homocysteine levels in patients with cryptogenic stroke considering the possible variables that may act as confounders and. Hyperhomocysteinemia an unidentified risk factor for stroke in our population sabaa asif 1, bashir a.
Sufferers are generally asymptomatic until the onset of premature arterial disease later in life. Ppt hyperhomocysteinemia a new cardiac risk factor. Relationship between homocysteine and ischemic stroke bjm vol. Hyperhomocysteinemia symptoms, diagnosis, treatments and.
Homocysteine is due to genetic and acquired factors poor diet in folate and vitamin b12, older age, renal impairment, thyroid diseases, and malignancies induced by the intake. Homocysteine, vitamins, and cardiovascular disease. The distributions of all biomarkers except egfr were skewed and. Homocystinuria is the property of its rightful owner. Elevated homocysteine levels in serum are an important risk factor for ischemic stroke and is associated with higher mortality. To answer the question directly, hyperhomocysteinemia is a significant risk factor for ischemic stroke as well as vascular events after the initial stroke stroke recurrence, ischemic heart. The jury is still out j mk murthy department of neurology, the institute of neurological sciences, care hospital, hyderabad, india.
Modest elevations of plasma homocysteine are independently associated with an increased incidence of venous thrombosis and arterial atherothrombotic diseases, including myocardial infarction and stroke. Prevention remains the optimal strategy to reduce the. The mechanisms underlying the pathophysiology of hyperhomocysteinemia are not completely defined, but endothelial dysfunction resulting from impaired bioavailability of nitric oxide is a consistent finding in experimental models. Soomro, kanwal sartaj, shafaq alvi 1resident, department of medicine, ziauddin medical university hospital. Some experts believe, however, that there is insufficient evidence to link hyperhomocysteinemia to thrombosis definitively. Hyperhomocysteinemia as a risk factor for ischemic stroke bioline. Role of homocysteine in the ischemic stroke and development of. Hyperhomocysteinemia has been shown to be associated with a number of neurological conditions like stroke,silent brain infarct, dementia, movement disorders, etc. The pathogenic role of hyperhomocysteinemia in cryptogenic stroke is not well established. Factors related with hyperhomocysteinemia hhcy and the impact of hhcy in parkinsons disease pd are not well understood. Ra patients are 2030% more likely to have higher homocysteine levels than the normal population in traditionallytreated dialysis patients, 91% of hd and 67% of pd.
Much evidence has shown that homocysteine hcy, a sulfurcontaining amino acid, is shown to be associated with cerebrovascular diseases,1, 2, 3 and an independent predictor of poor outcome in patients with stable and acute coronary diseases. Clinical studies suggested that acute ischemic stroke patients with hyperhomocysteinemia hhcy are at an increased risk for early. Thus the hope 2 study results probably do not apply to the indian population. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Moderate hyperhomocysteinemia occurs in 57% of general population, and is associated in the third and fourth deceny of life with premature coronary disease, stroke, arterial and venous.
Impairment of cerebrovascular reactivity by methioneinduced hyperhomocysteinemia and amelioration by quinapril treatment. Hyperhomocysteinemia an unidentified risk factor for. Homocystinuria is a rare autosomal recessive disorder characterized by severe elevations in plasma and urine homocysteine concentrations. Association of hyperhomocysteinemia with stroke recurrence. Hyperhomocysteinemia hhcy, as a consequence of impaired hcy metabolism or defects in crucial cofactors that participate in its recycling, is assumed as an independent human stroke risk factor. Neural cells are sensitive to prolonged hhcy treatment, because hcy cannot be metabolized either by the transsulfuration pathway or by the folate. Despite the impressive epidemiologic evidence that mild hyperhomocysteinemia is an independent risk factor for atherosclerotic and atherothrombotic vascular disease, we have become increasingly doubtful as to whether modest elevations of plasma homocysteine may be causally involved in the pathogenesis of atherosclerosis. Hyperhomocysteinemia is associated with ischemic cardiovascular disease icd and venous thromboembolism vte. If effective, the simplicity, availability, and presumably favorable side effect profile of hyperhomocysteinemia treatment with combined folic acid and oral b 6 and b 12 vitamin supplementation collectively referred to in. Hyperhomocysteinemia and stroke the ruby hall study. A modest elevation of plasma homocysteine concentration,commonly referred to as hyperhomocysteinaemia. Methylenetetrahydrofolate reductase polymorphism c677t. Abnormalities in thrombophilic profile are associated with enhanced risk of cerebral.