Mild hyperhomocysteinemia and low folate concentrations as risk factors for cervical arterial dissection.
OBJECTIVE
Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B(12) levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD.


METHODS
39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B(12) levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B(12), folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics.


RESULTS
Mean plasma fasting Hcy level was 9.81 mumol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66-35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6-31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034).


CONCLUSIONS
High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.
Arauz
Antonio
A
Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico. arauzg@prodigy.net.mx
Hoyos
Leticia
L
Cantú
Carlos
C
Jara
Aurelio
A
Martínez
Leticia
L
García
Irma
I
Fernández
María de Los Angeles
Mde L
Alonso
Elisa
E
D000293:Adolescent; D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000209:etiology*; D016022:Case-Control Studies; D002536:Cerebral Arteries; D002544:Cerebral Infarction / Q000097:blood / Q000208:ethnology / Q000209:etiology* / Q000235:genetics; D005215:Fasting / Q000097:blood; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications*; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008800:Mexico; D008875:Middle Aged; D009752:Nutritional Status / Q000208:ethnology; D016017:Odds Ratio; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020217:Vertebral Artery Dissection / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000209:etiology* / Q000235:genetics; D014805:Vitamin B 12 / Q000097:blood
D006710:Homocysteine; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D014805:Vitamin B 12