Stroke: Homocysteine Associated With Atherosclerosis of Cerebral Vessels

Sang-Beom Jeon, MD, PhD From the Department of Neurology Asan Medical Center University of Ulsan College of Medicine Seoul, Republic of Korea.MedicalResearch.com Interview with:
Sang-Beom Jeon, MD, PhD
From the Department of Neurology
Asan Medical Center
University of Ulsan College of Medicine
Seoul, Republic of Korea.

Medical Research: What are the main findings of the study?

Dr. Sang-Beom Jeon: In this MRI study of 825 stroke patients, we demonstrated that high plasma concentrations of homocysteine, also known as hyperhomocysteinemia, were associated with small-vessel disease (lacunar infarcts and leukoaraiosis) and large-vessel atherosclerosis of cerebral arteries.

Medical Research: Were any of the findings unexpected?

Dr. Sang-Beom Jeon: Hyperhomocysteinemia was related to the atherosclerosis of extracranial arteries, but not to the atherosclerosis of intracranial arteries. In multiple logistic regression analysis, however, hyperhomocysteinemia was not related to the atherosclerosis of extracranial arteries.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sang-Beom Jeon: Severe clinical trials failed to show a beneficial effect of B vitamin therapy on the development of stroke. However, the ingestion of B vitamins (folate, vitamin B6, and vitamin B12) may decrease the incidence of stroke, because

1) B vitamins can lower plasma concentrations of homocysteine,
2) the main outcomes of previous clinical trials consisted of stroke with sudden neurologic deficits, but small-vessel disease may cause an insidious cognitive decline, and 3) short follow-up durations (<5 years) of previous clinical trials may also be insufficient to observe anti-atherosclerosis effects of homocysteine-lowering treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sang-Beom Jeon: Future studies evaluating the benefits of homocysteine-lowering therapy need to include the extent of small-vessel disease and large-vessel atherosclerosis of cerebral arteries.

 

Citation:

Homocysteine, small-vessel disease, and atherosclerosis

An MRI study of 825 stroke patients

Sang-Beom Jeon, MD, PhD, Dong-Wha Kang, MD, PhD, Jong S. Kim, MD, PhD and Sun U. Kwon, MD, PhD

Published online before print July 16, 2014, doi: 10.1212/WNL.0000000000000720 Neurology10.1212/WNL.0000000000000720

 

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