PMID- 36436876 OWN - NLM STAT- MEDLINE DCOM- 20230905 LR - 20230915 IS - 1880-3873 (Electronic) IS - 1340-3478 (Print) IS - 1340-3478 (Linking) VI - 30 IP - 9 DP - 2023 Sep 1 TI - Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease. PG - 1198-1209 LID - 10.5551/jat.63849 [doi] AB - AIMS: We aimed to assess the prognostic impact of hyperhomocysteinemia (HHcy) on the recurrent vascular event risk in stroke patients with or without chronic kidney disease (CKD). METHODS: In this prospective observational study, 621 patients (mean age, 69.5 years; male, 62.2%) with ischemic stroke or transient ischemic attack were consecutively enrolled within 1 week of onset and followed-up for 1 year. HHcy was defined as elevated levels of fasting total homocysteine ＞15 micromol/L. CKD was defined as an estimated glomerular filtration rate of ＜60 mL/min/1.73 m(2) or a history of renal replacement therapy. The primary outcome was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death. RESULTS: The prevalence of HHcy was 18.5%. Patients with HHcy were more likely to have intracranial (37.4% versus 24.8%; p=0.008) and extracranial (20.9% versus 13.0%; p=0.037) artery stenosis than were those without HHcy. At 1 year, patients with HHcy were at a greater risk of MACE than were those without HHcy (annual rate, 17.8% versus 10.4%; log-rank p=0.033). In the Cox proportional hazard regression models, HHcy was independently associated with an increased risk of MACE in patients with CKD (adjusted hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.02-4.20), whereas HHcy was not predictive of MACE in those without CKD (adjusted HR, 1.00; 95% CI, 0.30-3.32). CONCLUSIONS: Elevated levels of serum homocysteine can be an important modifiable risk factor in stroke patients with CKD, but not in those without CKD. FAU - Mizuno, Takafumi AU - Mizuno T AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Hoshino, Takao AU - Hoshino T AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Ishizuka, Kentaro AU - Ishizuka K AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Toi, Sono AU - Toi S AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Takahashi, Shuntaro AU - Takahashi S AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Wako, Sho AU - Wako S AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Arai, Satoko AU - Arai S AD - Department of Neurology, Tokyo Women's Medical University Hospital. FAU - Kitagawa, Kazuo AU - Kitagawa K AD - Department of Neurology, Tokyo Women's Medical University Hospital. LA - eng PT - Journal Article PT - Observational Study DEP - 20221126 PL - Japan TA - J Atheroscler Thromb JT - Journal of atherosclerosis and thrombosis JID - 9506298 SB - IM MH - Humans MH - Male MH - Aged MH - *Hyperhomocysteinemia/complications/epidemiology MH - *Stroke/etiology/complications MH - *Renal Insufficiency, Chronic/complications MH - Risk Factors MH - *Ischemic Attack, Transient PMC - PMC10499453 OTO - NOTNLM OT - Atherosclerosis OT - Chronic kidney disease OT - Homocysteine OT - Prognosis OT - Stroke COIS- Dr. Kitagawa reports personal fees from Kyowa Kirin, grants and personal fees from Daiichi Sankyo, grants from Bayer, and grants from Dainihon Sumitomo outside the submitted work. Other authors have nothing to disclose. EDAT- 2022/11/28 06:00 MHDA- 2023/09/05 06:41 PMCR- 2023/09/01 CRDT- 2022/11/27 21:06 PHST- 2023/09/05 06:41 [medline] PHST- 2022/11/28 06:00 [pubmed] PHST- 2022/11/27 21:06 [entrez] PHST- 2023/09/01 00:00 [pmc-release] AID - DN/JST.JSTAGE/jat/63849 [pii] AID - 10.5551/jat.63849 [doi] PST - ppublish SO - J Atheroscler Thromb. 2023 Sep 1;30(9):1198-1209. doi: 10.5551/jat.63849. Epub 2022 Nov 26.