Skip to main content

Advertisement

SpringerLink
Log in

Homocysteine-lowering therapy and early functional outcomes of ischemic patients with H-type hypertension: a retrospective analysis of CNSR

  • Special Issue Article
  • Published:
Australasian Physical & Engineering Sciences in Medicine Aims and scope Submit manuscript

Abstract

Recently, elevated levels of homocysteine and early neurological deterioration due to acute ischemic stroke have been reported to be strongly correlated. However, the role of homocysteine-lowering therapy (HLT) in the prognosis of acute ischemic stroke patients has remained unclear. This study evaluated the effects of HLT during hospitalization on the early outcomes of the 792 ischemic stroke patients with H-type hypertension from the China National Stroke Registry. The subjects were divided into HLT and non-HLT groups. Demographic and laboratory information were collected, while the functional outcome at discharge and at 90 days follow-up were assessed by National Institutes of Health Stroke Scale and modified Rankin Scale (mRS) in both groups. We found that in the univariate analysis, the proportions of patients with good functional outcomes (mRS = 0–2) were 31.68 versus 29.36 % (OR 0.90, 95 % CI 0.66–1.22, p = 0.45) at discharge and 27.02 versus 28.30 % (OR 1.06, 95 % CI 0.77–1.45, p = 0.72) at 90 days follow-up for the HLT and non-HLT groups, respectively. After multivariate analysis, there was still no significant difference in the outcomes at discharge (OR 0.85, 95 % CI 0.53–1.36, p = 0.49) or at 90 days follow-up (OR 0.98, 95 % CI 0.60–1.60, p = 0.93) for the two groups. The findings of this study indicated that patients with HLT or not during hospitalization had no significant difference in early prognosis. We concluded that HLT during hospitalization did not improve the early functional outcomes of ischemic stroke patients who also had H-type hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mudd SH, Finkelstein JD, Refsum H et al (2002) Homocysteine and its disulfide derivatives: a suggested consensus terminology. Arterioscler Thromb Vasc Biol 20:1704–1706

    Article  Google Scholar 

  2. McCully KS (1969) Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol 56(1):111–128

    PubMed  CAS  PubMed Central  Google Scholar 

  3. Ganguly P, Alam SF (2015) Role of homocysteine in the development of cardiovascular disease. Nutr J 10(14):6

    Article  Google Scholar 

  4. Weiss N (2005) Mechanisms of increased vascular oxidant stress in hyperhomocys-teinemia and its impact on endothelial function. Curr Drug Metab 6:27–36

    Article  PubMed  CAS  Google Scholar 

  5. Abahji TN, Nill L, Ide N, Keller C, Hoffmann U, Weiss N (2007) Acute hyperhomocysteinemia induces microvascular and macrovascular endothelial dysfunction. Arch Med Res 38:411–416

    Article  PubMed  CAS  Google Scholar 

  6. Graham IM, Daly LE, Refsum HM et al (1997) Plasma homocysteine as a risk factor for vascular disease: the European concerted action project. JAMA 277(22):1775–1781

    Article  PubMed  CAS  Google Scholar 

  7. Kwon HM, Lee YS, Bae HJ (2014) Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke 45(3):871–873

    Article  PubMed  CAS  Google Scholar 

  8. Zhong C, Lv L, Liu C, Zhao L, Zhou M et al (2014) High homocysteine and blood pressure related to poor outcome of acute ischemia stroke in chinese population. PLoS One 9(9):e107498. doi:10.1371/journal.pone.0107498

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hankey GJ, Eikelboom JW, Baker RI et al (2010) B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial. Lancet Neurol 9:855–865

    Article  CAS  Google Scholar 

  10. Toole James F, Rene Malinow M, Chambless Lloyd E et al (2004) Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled Trial. JAMA 291(5):565–575

    Article  PubMed  CAS  Google Scholar 

  11. Ebbing M, Bønaa KH, Arnesen E et al (2010) Combined analyses and extended follow-up of two randomized controlled homocysteine-lowering B-vitamin trials. J Intern Med 268(4):367–382

    Article  PubMed  CAS  Google Scholar 

  12. Brustolin S, Giugliani R, Félix TM (2010) Genetics of homocysteine metabolism and associated disorders. Braz J Med Biol Res 43(1):1–7

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Lentz SR, Haynes WG (2004) Homocysteine: it is a clinically important cardiovascular risk factor? Clevel Clin J Med 71:729–734

    Article  Google Scholar 

  14. Cavalieri Margherita, Schmidt Reinhold, Chen Christopher et al (2012) B vitamins and magnetic resonance imaging-detected ischemic brain lesions in patients with recent transient ischemic attack or stroke the VITAmins TO Prevent Stroke (VITATOPS) MRI-Substudy. Stroke 43:3266–3270

    Article  PubMed  CAS  Google Scholar 

  15. Towfighi Amytis, Arshi Baback, Markovic Daniela et al (2014) Homocysteine-lowering therapy and risk of recurrent stroke, myocardial infarction and death: the impact of age in the VISP trial. Cerebrovasc Dis 37:263–267

    Article  PubMed  CAS  Google Scholar 

  16. Ji Y, Tan S, Xu Y (2013) Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis. Neurology 81(15):1298–1307

    Article  PubMed  CAS  Google Scholar 

  17. Wang Y, Cui L, Ji X, Dong Q et al (2011) The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics. Int J Stroke 6(4):355–361

    Article  PubMed  Google Scholar 

  18. Adams HP Jr, Bendixen BH, Kappelle LJ et al (1993) Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41

    Article  PubMed  Google Scholar 

  19. Bonita R, Beaglehole R (1988) Recovery of motor function after stroke. Stroke 19(12):1497–1500

    Article  PubMed  CAS  Google Scholar 

  20. Lonn E, Yusuf S, Arnold MJ et al (2006) Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 354(15):1567–1577

    Article  PubMed  CAS  Google Scholar 

  21. Arshi B, Ovbiagele B, Markovic D et al (2015) Differential effect of B-vitamin therapy by antiplatelet use on risk of recurrent vascular events after stroke. Stroke 46(3):870–873

    Article  PubMed  CAS  Google Scholar 

  22. Malinow MR, Bostom AG, Krauss RM (1999) Homocyst(e)ine, diet, and cardiovascular diseases:a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation 99:178–182

    Article  PubMed  CAS  Google Scholar 

  23. Sacco RL, Adams R, Albers G et al (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 37(2):577–617

    Article  PubMed  Google Scholar 

  24. Lee M, Hong KS, Chang SC et al (2010) Efficacy of homocysteine-lowering therapy with folic Acid in stroke prevention: a meta-analysis. Stroke 41(6):1205–1212

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Brouwer IA, van Dusseldorp M, Thomas CM et al (1999) Low-dose folic acid supplementation decreases plasma homocysteine concentrations: a randomized trial. Am J Clin Nutr 69(1):99–104

    PubMed  CAS  Google Scholar 

  26. Liu X, Shi M, Xia F (2015) The China Stroke Secondary Prevention Trial (CSSPT) protocol: a double-blinded, randomized, controlled trial of combined folic acid and B vitamins for secondary prevention of stroke. Int J Stroke 10(2):264–268

    Article  PubMed  Google Scholar 

  27. Okura T, Miyoshi KI, Irita J et al (2014) Hyperhomocysteinemia is one of the risk factors associated with cerebrovascular stiffness in hypertensive patients, especially elderly males. Sci Rep 4:5663. doi:10.1038/srep05663

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Acknowledgments

This work is supported by the Scientific Research Item of the Shenzhen Science and Technology Innovation Committee (JCYJ20140414170821262).

Author information

Authors and Affiliations

  1. Department of Neurology, Shenzhen University 1st Affiliated Hospital, Shenzhen Second People’s Hospital, Sungang West Road, Shenzhen, Guangdong, China

    Shiyu Hu & Lijie Ren

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Yilong Wang, Runhua Zhang, Xingquan Zhao, Liping Liu & Yongjun Wang

  3. Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University 1st Affiliated Hospital, Shenzhen, China

    Weiping Li

Authors
  1. Shiyu Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lijie Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yilong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Runhua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xingquan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Weiping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yongjun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lijie Ren.

Ethics declarations

Conflicts of interest

The authors declare no conflict of interest.

Additional information

Yilong Wang, Xingquan Zhao, Liping Liu and Yongjun Wang are China National Stroke Registry (CNSR) investigators.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hu, S., Ren, L., Wang, Y. et al. Homocysteine-lowering therapy and early functional outcomes of ischemic patients with H-type hypertension: a retrospective analysis of CNSR. Australas Phys Eng Sci Med 38, 785–791 (2015). https://doi.org/10.1007/s13246-015-0406-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13246-015-0406-x

Keywords

Search

Navigation