*Monika Chorazy1, Dominika Jakubowicz-Lachowska1, Michal Szczepanski1, Katarzyna Krystyna Snarska2, Agata Krajewska1, Marzena Wojewodzka-Zelezniakowicz3, Robert Jerzy Ladny3, Slawomir Lawicki4, Jan Kochanowicz1, Alina Kulakowska1
The relation between hyperhomocysteinemia and the intima-media complex thickness in common carotid artery, as risk factors for ischemic stroke
Zależność między hiperhomocysteinemią a grubością kompleksu intima media tętnic szyjnych wspólnych jako czynniki ryzyka udaru niedokrwiennego mózgu
1Department of Neurology, Medical University of Bialystok, Poland
2Department of Clinical Medicine, Medical University of Bialystok, Poland
3Department of Emergency Medicine, Medical University of Bialystok, Poland
4Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Poland
Streszczenie
Wstęp. W populacji ogólnej incydenty naczyniowo-mózgowe są trzecią najczęstszą przyczyną zgonów na świecie i najczęstszą przyczyną niepełnosprawności. Poza tradycyjnymi czynnikami ryzyka udaru niedokrwiennego mózgu, mogą występować inne, rzadsze zaburzenia, predysponujące do powikłań sercowo-naczyniowych, np. hiperhomocysteinemia.
Cel pracy. Określenie zależności między grubością KIM i poziomem homocysteiny u pacjentów z udarem niedokrwiennym mózgu.
Materiał i metody. Grupę badaną stanowiło 32 pacjentów z dokonanym, pierwszorazowym udarem niedokrwiennym mózgu. Grupę kontrolną stanowiło 28 osób zdrowych dobranych pod względem płci i wieku. Stężenie homocysteiny oznaczano w surowicy krwi za pomocą analizatora immunologicznego IMX firmy ABBOTT. Badanie grubości błony wewnętrznej i środkowej tętnic szyjnych (KIM) wykonano aparatem Sonoline ELEGRA z użyciem sondy liniowej 7,5 L 40 przy częstotliwości 9 MHz.
Wyniki. Średnie stężenie homocysteiny u pacjentów z udarem niedokrwiennym mózgu wyniosło 16,55 umol/L. Podwyższone wartości stwierdzono u 20 pacjentów z grupy badanej. W badaniu dopplerowskim tętnic szyjnych, średnia grubość KIM u chorych z udarem mózgu wynosiła 0,88. Następnie oceniono zależności między poziomem homocysteiny a grubością KIM – w grupie kontrolnej oraz u pacjentów z udarem mózgu.
Wnioski. Występuje zależność między współistnieniem hiperhomocysteinemii i zwiększoną grubością KIM u młodych pacjentów z udarem niedokrwiennym mózgu.
Summary
Introduction. Cerebrovascular events are the third most frequent cause of death globally and the most common cause of disability in the general population. There may be other, rarer disorders predisposing to cardiovascular complications, besides traditional risk factors of ischemic stroke, as the data prove, one of them is hyperhomocysteinemia.
Aim. Relation between intima-media complex thickness (IMT) and homocysteine level in patients with ischemic stroke.
Material and methods. The study group consisted of 32 patients with first-ever ischemic stroke diagnosed. The control group contained of 28 healthy people matched in terms of gender and age. The concentration of homocysteine was measured in the blood serum using the IMX immunoassay ABBOTT analyzer. Evaluation of intima-media thickness of carotid arteries was performed with Sonoline ELEGRA using a 7.5 L 40 line probe at 9 MHz.
Results. The average homocysteine concentration in patients with ischemic stroke was 16.55 umol/L. Elevated values of homocysteine were found in 20 patients. In Doppler examination of the carotid arteries, the mean IMT in patients with stroke was 0.88. The correlations between the homocysteine level and the IMT were evaluated- in the control group and in patients with stroke.
Conclusions. There is relationship between hyperhomocysteinemia and increased thickness IMT in young patient with ischemic stroke.
Introduction
Cerebrovascular events are the third most frequent cause of death globally and the most common cause of disability in the general population (1).
Ischemic stroke is a consequence of the coexistence of comorbidities and the presence of factors conducive to the development of changes in the vessels of micro- and macrocirculation. There may be other, rarer disorders predisposing to cardiovascular complications, besides traditional risk factors of ischemic stroke, as the data prove. One of them is hyperhomocysteinemia (2-4).
Even mild hyperhomocysteinemia (hHcy) may increase the risk of ischemic stroke, as has been confirmed in studies. The prevalence of hyperhomocysteinemia in people with stroke is 19-42% (4, 5).
Homocysteine is a sulfuric aminoacid, that is converted into cysteine or methionine under physiological conditions. Hyperhomocysteinemia is associated mainly with genetically determined deficiency of cystathionine β-synthase and deficiency of methylenetetrahydrofolate reductase (6, 7).
Hyperhomocysteinemia is more common in the elderly, male, those with folic acid, B6 and B12 vitamins deficiency, alcohol and caffeine abusers, tobacco-smokers, those treated with certain drugs (methotrexate, phenytoin, carbamazepines, folic acid antagonists, levodopa) and suffering from certain diseases like malignant tumors, hypothyroidism, Alzheimer’s disease or arterial hypertension (5-7).
High concentration of homocysteine activity damage of vascular endothelium (through cytotoxic activity) (5). In addition, homocysteine shows a pro-thrombotic effect by neutralizing vasodilatatory effect of NO through binding it – which leads to the vasoconstriction and increased platelet aggregation ability, may lead to the occurrence of arterial and venous thrombosis in organs (brain, myocardium, lungs and kidneys) (8). Also contributes to the modification of cholesterol fractions LDL and HDL, intensification of the inflammatory condition and disregulation of coagulation and fibrinolysis processes (6). Therefore, hyperhomocysteinemia has been recognized in recent years as a risk factor for ischemic strokes.
The thickness of the internal membrane and carotid median membrane (intima-media complex thickness – IMT) can be considered as a morphological exponent of the risk factors for atherosclerosis and ischemic stroke. It has been proved, that there is a clear, positive correlation between the thickness of intima-media complex and the risk of ischemic stroke (9-11). So far, many studies have been published, that show relationship between structural changes in the carotid vascular wall, expressed in IM thickening, presence of atherosclerotic plaques, and exposure to the basic risk factors for stroke. In addition, IMT (intima-media thickness) increases linearly with age (12), and therefore seems to be a good determinant of the biological age of vessels (9).
Aim
As a consequence of the above mentioned, the aim of the study was to determine relation between intima-media complex thickness (IMT) and homocysteine level in patients with ischemic stroke.
Material and methods
The study group consisted of 32 patients with first-ever ischemic stroke diagnosed according to the criteria adopted in the Classification of Cerebrovascular Diseases III (13). In all of the patients examined, the diagnosis of ischemic stroke was confirmed by the computed tomography of the head, carried out within 24 hours of the onset of clinical symptoms of the disease. To eliminate patients with ischemic stroke resulting from cardiac embolism, in which the occurrence of stroke may be determined by valvular or arrhythmic disorders, those with permanent and paroxysmal atrial fibrillation, valvular defects and left ventricular hypertrophy were excluded from our study.
The control group contained of 28 healthy people matched in terms of gender and age. Examinations of persons from the control group were carried out after obtaining their written consent. The homocysteine concentration in the blood serum and the IMT were determined in all subjects.
The concentration of homocysteine was measured in the blood serum using the IMX immunoassay analyzer from ABBOTT. A type of FPIA (Fluorescent Polarization Immunoassay) reaction, i.e. an enzyme-based immunoenzymatic reaction based on fluorescence polarization, was used for this purpose.
Evaluation of intima-media thickness of carotid arteries was performed with Sonoline ELEGRA using a 7.5 L 40 line probe at 9 MHz. IMT was obtained using module for automated measurement.
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