Homocysteine and cerebral small vessel disease in patients with symptomatic atherosclerotic disease. The SMART-MR study.

Abstract:

OBJECTIVE:High homocysteine level is a risk factor for atherosclerosis and has been associated with lacunar infarcts (LIs), white matter lesions (WML) and cognitive dysfunction. It is unclear whether homocysteine is associated with cerebral small vessel disease (cSVD) on top of pre-existent atherosclerosis. We evaluated the association between homocysteine and cSVD in a large cohort of patients with symptomatic atherosclerotic disease. METHODS:Within the SMART-MR study, a prospective cohort study of patients with symptomatic atherosclerotic disease, we estimated cross-sectional associations of total plasma homocysteine (THCY) and hyperhomocysteinemia (HHCY) with WML volume and presence of LI, using automated brain segmentation in MRIs of 1232 patients and cognitive function in 763 patients. WML were expressed as a logarithmic transformed percentage of total brain volume. RESULTS:Linear regression analyses adjusted for age, sex, vascular risk factors and extent of atherosclerosis showed that THCY and HHCY were significantly associated with larger WML volumes (B=0.01%: 95% CI 0.002-0.02%, and B=0.21%: 95% CI 0.04-0.39%). Increasing THCY was significantly associated with an increased risk of LIs (OR 1.04, 95% CI 1.01-1.07, per 1 μmol). Moreover, HHCY was associated with worse cognitive function (B=-0.12: 95% CI -0.22 to -0.01). CONCLUSION:In patients with symptomatic atherosclerotic disease, higher homocysteine levels are associated with higher WML volume, presence of LI and slightly worse cognitive function.

journal_name

Atherosclerosis

journal_title

Atherosclerosis

authors

Kloppenborg RP,Nederkoorn PJ,van der Graaf Y,Geerlings MI

doi

10.1016/j.atherosclerosis.2011.02.027

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

461-6

issue

2

eissn

0021-9150

issn

1879-1484

pii

S0021-9150(11)00188-2

journal_volume

216

pub_type

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