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Hyperhomocysteinemia is Associated with Aortic Atheroma Progression in Stroke/TIA Patients.

Sen S, Reddy PL, Grewal RP, Busby M, Chang P, Hinderliter A - Front Neurol (2010)

Bottom Line: Patients had evaluation for vascular risk factors, dietary factors (folate, B12 and pyridoxine), and methylene tetrahydrofolate reductase (MTHFR) polymorphism.Of the 118 patients, 33 (28%) showed progression and 17 (14%) showed regression of their index arch lesion at 1 year. tHcy (≥14.0 μmol/l) was significantly associated with progression on both univariate (RR = 3.4, 95% CI 2.0-5.8) and multivariate analyses (adjusted RR = 3.6, 95% CI 2.2-4.6).The changes in AA plaque thickness (r(2) = 0.11; p < 0.001) and AA plaque area (r(2) = 0.08; p = 0.002) correlated with tHcy. tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of South Carolina School of Medicine Columbia, SC, USA.

ABSTRACT

Significance: Aortic arch (AA) atheroma and AA atheroma progression are independent risk factors for recurrent vascular events in stroke/transient ischemic attack (TIA) patients. Total homocysteine level (tHcy) is an independent risk marker for atherosclerosis including that found in AA. The purpose of this study was to prospectively test the association between AA atheroma progression and tHcy.

Methods: This is a cohort study of 307 consecutive hospitalized stroke/TIA patients undergoing transesophageal echocardiogram (TEE) as a part of their clinical workup. Measurable AA atheroma was detected in 167 patients of whom 125 consented to a protocol-mandated follow-up TEE at 12 months. Patients had evaluation for vascular risk factors, dietary factors (folate, B12 and pyridoxine), and methylene tetrahydrofolate reductase (MTHFR) polymorphism. One hundred eighteen stroke/TIA patients had tHcy, acceptable paired AA images, and detailed plaque measurements. An increase by ≥1 grade of AA atheroma was defined as progression.

Results: Of the 118 patients, 33 (28%) showed progression and 17 (14%) showed regression of their index arch lesion at 1 year. tHcy (≥14.0 μmol/l) was significantly associated with progression on both univariate (RR = 3.4, 95% CI 2.0-5.8) and multivariate analyses (adjusted RR = 3.6, 95% CI 2.2-4.6). The changes in AA plaque thickness (r(2) = 0.11; p < 0.001) and AA plaque area (r(2) = 0.08; p = 0.002) correlated with tHcy. tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02).

Conclusions: Our results validate the association and a linear correlation between tHcy and progression of AA atheroma.

No MeSH data available.


Related in: MedlinePlus

(A) A correlation (r2 = 0. 11, p < 0.001) was noted between the change (Δ) in AA plaque thickness over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot. (B) A correlation (r2 = 0.08, p = 0.002) was noted between the change (Δ) in AA plaque area over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot.
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Figure 2: (A) A correlation (r2 = 0. 11, p < 0.001) was noted between the change (Δ) in AA plaque thickness over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot. (B) A correlation (r2 = 0.08, p = 0.002) was noted between the change (Δ) in AA plaque area over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot.

Mentions: There was no significant correlation (r2 = 0.01, p = 0.31) between baseline AA plaque thickness on initial TEE and fasting plasma homocysteine level. Also, a significant correlation (r2 = 0.01, p = 0.29) was not noted between baseline AA plaque area and fasting plasma homocysteine level. However, a correlation (r2 = 0.11; p < 0.001) between baseline fasting homocysteine levels and the change (Δ) in AA plaque thickness was observed, as shown in Figure 2A. Likewise, there was a correlation (r2 = 0.08; p = 0.002) between baseline fasting homocysteine levels and the change (Δ) in AA plaque area, as shown in Figure 2B. Plasma tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02) as noted in Table 2.


Hyperhomocysteinemia is Associated with Aortic Atheroma Progression in Stroke/TIA Patients.

Sen S, Reddy PL, Grewal RP, Busby M, Chang P, Hinderliter A - Front Neurol (2010)

(A) A correlation (r2 = 0. 11, p < 0.001) was noted between the change (Δ) in AA plaque thickness over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot. (B) A correlation (r2 = 0.08, p = 0.002) was noted between the change (Δ) in AA plaque area over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008913&req=5

Figure 2: (A) A correlation (r2 = 0. 11, p < 0.001) was noted between the change (Δ) in AA plaque thickness over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot. (B) A correlation (r2 = 0.08, p = 0.002) was noted between the change (Δ) in AA plaque area over a 12-month interval and fasting plasma homocysteine level (log-transformed), depicted in a semi-log scatter plot.
Mentions: There was no significant correlation (r2 = 0.01, p = 0.31) between baseline AA plaque thickness on initial TEE and fasting plasma homocysteine level. Also, a significant correlation (r2 = 0.01, p = 0.29) was not noted between baseline AA plaque area and fasting plasma homocysteine level. However, a correlation (r2 = 0.11; p < 0.001) between baseline fasting homocysteine levels and the change (Δ) in AA plaque thickness was observed, as shown in Figure 2A. Likewise, there was a correlation (r2 = 0.08; p = 0.002) between baseline fasting homocysteine levels and the change (Δ) in AA plaque area, as shown in Figure 2B. Plasma tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02) as noted in Table 2.

Bottom Line: Patients had evaluation for vascular risk factors, dietary factors (folate, B12 and pyridoxine), and methylene tetrahydrofolate reductase (MTHFR) polymorphism.Of the 118 patients, 33 (28%) showed progression and 17 (14%) showed regression of their index arch lesion at 1 year. tHcy (≥14.0 μmol/l) was significantly associated with progression on both univariate (RR = 3.4, 95% CI 2.0-5.8) and multivariate analyses (adjusted RR = 3.6, 95% CI 2.2-4.6).The changes in AA plaque thickness (r(2) = 0.11; p < 0.001) and AA plaque area (r(2) = 0.08; p = 0.002) correlated with tHcy. tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of South Carolina School of Medicine Columbia, SC, USA.

ABSTRACT

Significance: Aortic arch (AA) atheroma and AA atheroma progression are independent risk factors for recurrent vascular events in stroke/transient ischemic attack (TIA) patients. Total homocysteine level (tHcy) is an independent risk marker for atherosclerosis including that found in AA. The purpose of this study was to prospectively test the association between AA atheroma progression and tHcy.

Methods: This is a cohort study of 307 consecutive hospitalized stroke/TIA patients undergoing transesophageal echocardiogram (TEE) as a part of their clinical workup. Measurable AA atheroma was detected in 167 patients of whom 125 consented to a protocol-mandated follow-up TEE at 12 months. Patients had evaluation for vascular risk factors, dietary factors (folate, B12 and pyridoxine), and methylene tetrahydrofolate reductase (MTHFR) polymorphism. One hundred eighteen stroke/TIA patients had tHcy, acceptable paired AA images, and detailed plaque measurements. An increase by ≥1 grade of AA atheroma was defined as progression.

Results: Of the 118 patients, 33 (28%) showed progression and 17 (14%) showed regression of their index arch lesion at 1 year. tHcy (≥14.0 μmol/l) was significantly associated with progression on both univariate (RR = 3.4, 95% CI 2.0-5.8) and multivariate analyses (adjusted RR = 3.6, 95% CI 2.2-4.6). The changes in AA plaque thickness (r(2) = 0.11; p < 0.001) and AA plaque area (r(2) = 0.08; p = 0.002) correlated with tHcy. tHcy was associated with change in plaque thickness over 12 months, independent of age, dietary factors, renal function and MTHFR polymorphism (Standardized β-coefficient 0.335, p = 0.02).

Conclusions: Our results validate the association and a linear correlation between tHcy and progression of AA atheroma.

No MeSH data available.


Related in: MedlinePlus