The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation

Lorenzo Loffredo, Francesco Violi, Filippo Luca Fimognari, Roberto Cangemi, Pier Sandro Sbrighi, Francesca Sampietro, Giuseppina Mazzola, Vito Nicola Di Lecce, Armando D'Angelo

Research output: Contribution to journalArticle

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Abstract

Background and Objectives. Atrial fibrillation is complicated by a high rate of ischemic stroke. Previous studies have shown that an increased level of circulating total plasma homocysteine (tHcy) is an independent predictor of stroke, but it is unclear whether it is also predictive of stroke in patients with atrial fibrillation. The objective of this study was to evaluate whether increased tHcy is an independent predictor of cardio-embolic stroke in patients with non-valvular atrial fibrillation. Design and Methods. We studied 163 consecutive patients (77 males and 86 females; mean age 72.3±8.8 years) with permanent (n=118) or paroxysmal (n=45) atrial fibrillation of non-valvular origin hospitalized for cardiac reasons. Ischemic stroke, documented by nuclear magnetic resonance or computerized tomography imaging, had occurred at an average of 2 years before hospitalization in 40 patients (16 males and 24 females, mean age 74.8±8.8 years). Fasting tHcy levels were determined by high performance liquid chromatography. Results. Multivariate analysis adjusting for traditional cardiovascular risk factors, thromboembolic risk factors and predictors of tHcy (glomerular filtration rate, uric acid, gender) and fibrinogen levels (age, alcohol intake) showed that total homocysteine (OR:1.056; for each 1 μmol/L increase, 95% C.I.: 1.00-1.12; p=0.042) and fibrinogen (OR:1.008 for each 1 mg/dL increase; 95% C.I.: 1.00-1.014; p=0.016) were independently associated with ischemic stroke. With respect to patients in the first quartile of the tHcy distribution (4.6-7.5 μmol/L), patients in the fourth quartile of the tHcy distribution (18.7-67.1 μmol/L) had a 2.73-fold increased probability of ischemic stroke Interpretations and Conclusions. In patients with non-valvular atrial fibrillation hospitalized for cardiac reasons, increased fasting tHcy levels are independently associated with a history of ischemic stroke.

Original languageEnglish
Pages (from-to)1205-1211
Number of pages7
JournalHaematologica
Volume90
Issue number9
Publication statusPublished - Sep 2005

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Hyperhomocysteinemia
Homocysteine
Atrial Fibrillation
Stroke
Fibrinogen
Fasting
Uric Acid
Glomerular Filtration Rate
Hospitalization
Magnetic Resonance Spectroscopy
Multivariate Analysis
High Pressure Liquid Chromatography
Tomography
Alcohols

Keywords

  • Cardiovascular risk factors
  • Fibrinogen
  • Glomerular filtration rate
  • Homocysteine
  • Ischemic stroke
  • Non-valvular atrial fibrillation

ASJC Scopus subject areas

  • Hematology

Cite this

Loffredo, L., Violi, F., Fimognari, F. L., Cangemi, R., Sbrighi, P. S., Sampietro, F., ... D'Angelo, A. (2005). The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation. Haematologica, 90(9), 1205-1211.

The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation. / Loffredo, Lorenzo; Violi, Francesco; Fimognari, Filippo Luca; Cangemi, Roberto; Sbrighi, Pier Sandro; Sampietro, Francesca; Mazzola, Giuseppina; Di Lecce, Vito Nicola; D'Angelo, Armando.

In: Haematologica, Vol. 90, No. 9, 09.2005, p. 1205-1211.

Research output: Contribution to journalArticle

Loffredo, L, Violi, F, Fimognari, FL, Cangemi, R, Sbrighi, PS, Sampietro, F, Mazzola, G, Di Lecce, VN & D'Angelo, A 2005, 'The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation', Haematologica, vol. 90, no. 9, pp. 1205-1211.
Loffredo L, Violi F, Fimognari FL, Cangemi R, Sbrighi PS, Sampietro F et al. The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation. Haematologica. 2005 Sep;90(9):1205-1211.
Loffredo, Lorenzo ; Violi, Francesco ; Fimognari, Filippo Luca ; Cangemi, Roberto ; Sbrighi, Pier Sandro ; Sampietro, Francesca ; Mazzola, Giuseppina ; Di Lecce, Vito Nicola ; D'Angelo, Armando. / The association between hyperhomocysteinemia and ischemic stroke in patients with non-valvular atrial fibrillation. In: Haematologica. 2005 ; Vol. 90, No. 9. pp. 1205-1211.
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abstract = "Background and Objectives. Atrial fibrillation is complicated by a high rate of ischemic stroke. Previous studies have shown that an increased level of circulating total plasma homocysteine (tHcy) is an independent predictor of stroke, but it is unclear whether it is also predictive of stroke in patients with atrial fibrillation. The objective of this study was to evaluate whether increased tHcy is an independent predictor of cardio-embolic stroke in patients with non-valvular atrial fibrillation. Design and Methods. We studied 163 consecutive patients (77 males and 86 females; mean age 72.3±8.8 years) with permanent (n=118) or paroxysmal (n=45) atrial fibrillation of non-valvular origin hospitalized for cardiac reasons. Ischemic stroke, documented by nuclear magnetic resonance or computerized tomography imaging, had occurred at an average of 2 years before hospitalization in 40 patients (16 males and 24 females, mean age 74.8±8.8 years). Fasting tHcy levels were determined by high performance liquid chromatography. Results. Multivariate analysis adjusting for traditional cardiovascular risk factors, thromboembolic risk factors and predictors of tHcy (glomerular filtration rate, uric acid, gender) and fibrinogen levels (age, alcohol intake) showed that total homocysteine (OR:1.056; for each 1 μmol/L increase, 95{\%} C.I.: 1.00-1.12; p=0.042) and fibrinogen (OR:1.008 for each 1 mg/dL increase; 95{\%} C.I.: 1.00-1.014; p=0.016) were independently associated with ischemic stroke. With respect to patients in the first quartile of the tHcy distribution (4.6-7.5 μmol/L), patients in the fourth quartile of the tHcy distribution (18.7-67.1 μmol/L) had a 2.73-fold increased probability of ischemic stroke Interpretations and Conclusions. In patients with non-valvular atrial fibrillation hospitalized for cardiac reasons, increased fasting tHcy levels are independently associated with a history of ischemic stroke.",
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AU - Violi, Francesco

AU - Fimognari, Filippo Luca

AU - Cangemi, Roberto

AU - Sbrighi, Pier Sandro

AU - Sampietro, Francesca

AU - Mazzola, Giuseppina

AU - Di Lecce, Vito Nicola

AU - D'Angelo, Armando

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N2 - Background and Objectives. Atrial fibrillation is complicated by a high rate of ischemic stroke. Previous studies have shown that an increased level of circulating total plasma homocysteine (tHcy) is an independent predictor of stroke, but it is unclear whether it is also predictive of stroke in patients with atrial fibrillation. The objective of this study was to evaluate whether increased tHcy is an independent predictor of cardio-embolic stroke in patients with non-valvular atrial fibrillation. Design and Methods. We studied 163 consecutive patients (77 males and 86 females; mean age 72.3±8.8 years) with permanent (n=118) or paroxysmal (n=45) atrial fibrillation of non-valvular origin hospitalized for cardiac reasons. Ischemic stroke, documented by nuclear magnetic resonance or computerized tomography imaging, had occurred at an average of 2 years before hospitalization in 40 patients (16 males and 24 females, mean age 74.8±8.8 years). Fasting tHcy levels were determined by high performance liquid chromatography. Results. Multivariate analysis adjusting for traditional cardiovascular risk factors, thromboembolic risk factors and predictors of tHcy (glomerular filtration rate, uric acid, gender) and fibrinogen levels (age, alcohol intake) showed that total homocysteine (OR:1.056; for each 1 μmol/L increase, 95% C.I.: 1.00-1.12; p=0.042) and fibrinogen (OR:1.008 for each 1 mg/dL increase; 95% C.I.: 1.00-1.014; p=0.016) were independently associated with ischemic stroke. With respect to patients in the first quartile of the tHcy distribution (4.6-7.5 μmol/L), patients in the fourth quartile of the tHcy distribution (18.7-67.1 μmol/L) had a 2.73-fold increased probability of ischemic stroke Interpretations and Conclusions. In patients with non-valvular atrial fibrillation hospitalized for cardiac reasons, increased fasting tHcy levels are independently associated with a history of ischemic stroke.

AB - Background and Objectives. Atrial fibrillation is complicated by a high rate of ischemic stroke. Previous studies have shown that an increased level of circulating total plasma homocysteine (tHcy) is an independent predictor of stroke, but it is unclear whether it is also predictive of stroke in patients with atrial fibrillation. The objective of this study was to evaluate whether increased tHcy is an independent predictor of cardio-embolic stroke in patients with non-valvular atrial fibrillation. Design and Methods. We studied 163 consecutive patients (77 males and 86 females; mean age 72.3±8.8 years) with permanent (n=118) or paroxysmal (n=45) atrial fibrillation of non-valvular origin hospitalized for cardiac reasons. Ischemic stroke, documented by nuclear magnetic resonance or computerized tomography imaging, had occurred at an average of 2 years before hospitalization in 40 patients (16 males and 24 females, mean age 74.8±8.8 years). Fasting tHcy levels were determined by high performance liquid chromatography. Results. Multivariate analysis adjusting for traditional cardiovascular risk factors, thromboembolic risk factors and predictors of tHcy (glomerular filtration rate, uric acid, gender) and fibrinogen levels (age, alcohol intake) showed that total homocysteine (OR:1.056; for each 1 μmol/L increase, 95% C.I.: 1.00-1.12; p=0.042) and fibrinogen (OR:1.008 for each 1 mg/dL increase; 95% C.I.: 1.00-1.014; p=0.016) were independently associated with ischemic stroke. With respect to patients in the first quartile of the tHcy distribution (4.6-7.5 μmol/L), patients in the fourth quartile of the tHcy distribution (18.7-67.1 μmol/L) had a 2.73-fold increased probability of ischemic stroke Interpretations and Conclusions. In patients with non-valvular atrial fibrillation hospitalized for cardiac reasons, increased fasting tHcy levels are independently associated with a history of ischemic stroke.

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