Different impact of hyperhomocysteinemia on cerebral small vessel ischemia and cervico-cerebral atherosclerosis in non-stroke individuals

Abstract

Background: Our aim was to investigate the impact of plasma total homocysteine (tHcyt) levels on cervico-cerebral atherosclerosis and cerebral small vessel ischemia in non-stroke individuals.

Methods: Demographic, laboratory, brain magnetic resonance imaging and magnetic resonance angiographic data were retrospectively analyzed in 682 non-stroke individuals. The association between plasma tHcyt and radiological indices of cervico-cerebral atherosclerosis (any presence of cervico-cerebral [aCC] atherosclerosis, extracranial [EC] atherosclerosis and intracranial [IC] atherosclerosis) and cerebral small vessel ischemia (silent brain infarct [SBI] and cerebral white matter hyperintensity [cWMH]) was analyzed after adjusting for cardiovascular risk factors.

Results: There was no association between values for natural log-transformed tHcyt (log-Hcyt) and aCC atherosclerosis, EC atherosclerosis, or IC atherosclerosis. The log-Hcyt was independently associated with cWMH (OR: 3.07, 95% CI: 1.64-5.75) and SBI (OR: 2.91, 95% CI: 1.57-5.40) in multivariate analysis. Median plasma tHcyt level increased as the severity of cWMH increased.

Conclusions: Our results suggest that hyperhomocysteinemia plays a major role in the development of cerebral small vessel ischemia, but not in the development of atherosclerosis of major cerebral arteries.