Emerging risk factors for ischemic stroke.
The strongest evidence of a relationship between homocysteine (Hcy) and risk of cerebrovascular disease has been provided by six prospective studies. The vascular risk was shown to be dose dependent for both fasting and postmethionine Hcy levels and statistically independent of traditional cardiovascular risk factors, although there was a multiple effect in the presence of smoking and hypertension. Recently, it was demonstrated that not only hyperHcy but also MTHFR polymorphism is an independent risk factor for dissection. Finally, preliminary data suggest that hyperHcy is a risk factor for the occurrence of cerebrovascular events (transient ischemic attack/stroke) in patients with atrial fibrillation. On the basis of these results, several intervention trials are ongoing to determine whether lowering Hcy levels with vitamin supplementation will reduce the recurrence of stroke.
Abbate
R
R
Dipartimento Area Critica Medico-Chirurgica, Università di Firenze, Centro Trombosi, AO Careggi, Italy.
Sofi
F
F
Brogi
D
D
Marcucci
R
R
D015415:Biomarkers / Q000032:analysis; D002545:Brain Ischemia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology*; D008403:Mass Screening / Q000379:methods; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D000587:Oxidoreductases Acting on CH-NH Group Donors / Q000235:genetics; D011110:Polymorphism, Genetic; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology
D015415:Biomarkers; D000587:Oxidoreductases Acting on CH-NH Group Donors; D042965:Methylenetetrahydrofolate Reductase (NADPH2)