Correlation between Metabolic Syndrome and Plasma Homocysteine Level in Patients with Silent Lacunar Infarction

무증상성 열공성 뇌경색 환자에서 호모시스테인과 대사증후군의 상관관계에 대한 연구

  • Shin, Yoon-Ri (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Lee, Jae-Wook (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Lee, Seung-Yeon (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Yun, Yong-Jae (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Jeong, Hyun-Yun (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Kim, Kyoung-Min (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University) ;
  • Kim, Young-Kyun (Dept. of Internal Medicine, College of Oriental Medicine, Dong-Eui University)
  • 신윤리 (동의대학교 한의과대학 내과학교실) ;
  • 이재욱 (동의대학교 한의과대학 내과학교실) ;
  • 이승연 (동의대학교 한의과대학 내과학교실) ;
  • 윤용재 (동의대학교 한의과대학 내과학교실) ;
  • 정현윤 (동의대학교 한의과대학 내과학교실) ;
  • 김경민 (동의대학교 한의과대학 내과학교실) ;
  • 김영균 (동의대학교 한의과대학 내과학교실)
  • Published : 2012.09.30

Abstract

Objectives : This clinical study was done to examine metabolic syndrome (MS) and plasma homocysteine (HCY) level in patients with silent lacunar infarction (SLI) and in normal controls. Methods : A total of 154 patients, who were over 20 years of age and visited the stroke prevention check-up center of a university hospital from December 2006 to December 2010, were examined by brain CT or brain MRI, and classified into two groups. We compared the components of MS and HCY levels between patients with SLI (n=74) and normal controls (n=80). Modified ATP III definition was used for diagnosis of MS while Korean standard for waist circumference was used. Results : Prevalence of MS was significantly higher in the SLI group than the normal group. HCY was also significantly higher in the SLI group than the noraml, and the odds ratio (OR) for SLI, comparing high HCY level (${\geq}10{\mu}mol/L$) with low HCY level ($<10{\mu}mol/L$), was 3.64 (95% confidence interval (CI); 1.81-7.29, p<.0001). However, there was no correlation between MS and HCY in the SLI group. Prevalence of diabetes and hypertension (HT) was higher in the SLI group than the normal group, but there was no significant difference in blood lipids level between the SLI and normal groups. Of note, HT itself was enough to be an independent risk factor for SLI (OR; 4.58, 95% CI; 1.91-11.01, p=0.001). Body mass index, waist circumference, waist-hip ratio and visceral fat area were significantly higher in the SLI than normal group, and visceral fat area was enough to be an independent risk factor for SLI (OR; 2.41, 95% CI; 1.04-5.59, p=0.040). Conclusions : SLI is shown to have significant correlation with HCY and prevalence of MS, however there is no relationship between HCY and prevalence of MS in patients with SLI.

Keywords

References

  1. Wardlaw JM, Sandercock PA, Dennis MS, Starr J. Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke 2003;34:806-812. https://doi.org/10.1161/01.STR.0000058480.77236.B3
  2. Kim HG, Chang SH, Park SK, Lee KS, Kim HS, Kim WS. A Neurobehavioral Performance Assessment in Lacunar Infarction Case-control Study. Korean J Prev Med 2003;36(3):255-262. https://doi.org/10.1016/S0091-7435(02)00028-2
  3. Norrving B. Long-term prognosis after lacunar infarction. Lancet 2003;2:238-245. https://doi.org/10.1016/S1474-4422(03)00352-1
  4. Kim DK, Lee SB, Kim JM. Lacunar Infarcts: Significance of Volume, Lesion Location and Risk Factors. J Korean Neurol Assoc 1993;11(3):302-329.
  5. Isomaa B, Almgren P, Tuomi T, Forsen B, Lathi K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-689. https://doi.org/10.2337/diacare.24.4.683
  6. Kernan WN, Inzucchi SE, Viscoli CM, Brass LM, Bravara DM, Horwitz RI. Insulin resistance and risk for stroke. Neurology 2002;59:809-815. https://doi.org/10.1212/WNL.59.6.809
  7. Lee KU. Oxidative stress markers in Korean subjects in insulin resistance syndrome. Diabetes Res Clin Pract 2001;54(suppl.2):29-33.
  8. Durand P, Prost M, Loreau N, Lussier-Cacan S, Blache D. Impaired homocysteine metabolism and atherothrombotic disease. Lab Invest 2001; 81:645-672. https://doi.org/10.1038/labinvest.3780275
  9. Welch GN, Loscalzo J. Homocysteine and atherothrombosis. N Engl J Med 1998;338(15) :1042-1050. https://doi.org/10.1056/NEJM199804093381507
  10. Park K, Yasuda N, Toyonaga S, Tsubosack E, Nakabayashi H, Shimizu K. Siginificant associations of metabolic syndrome and its components with silent lacunar infarction in middle aged subjects. J Neurol Neurosurg Psychiatry 2008; 79(6):719-721.
  11. Glueck CJ, Shaw P, Lang JE, Tracy T, Smith LS, Wang Y. Evidence that homocysteine is an independent risk factor for atherosclerosis in hyperlipidemic patients. Am J Cardiol 1995;75 :132-136. https://doi.org/10.1016/S0002-9149(00)80061-2
  12. Clarke R, Daly L, Robinson K, Naughten E, Cahalane S, Fowler B, et al. Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 1991;324:1149-1155. https://doi.org/10.1056/NEJM199104253241701
  13. Third Report of the National Cholesterol Education Program(NCEP) Expert panel on Detection, Evalution and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-3421.
  14. Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18 :499-502.
  15. Lee SY, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, et al. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obesity 2006;15:1-9.
  16. Shim DS, Park SK, Kim JS, Yoo JY, Kim BS, Jung SL, et al. Prevalence and risk factors of silent cerebral infarction in normal adults - single institute study-. J Korean Neurol Assoc 2005;23(3):303-306.
  17. Caplan LR. Silent brain infarcts. Cerebrovascular Dis 1994;4(suppl.1):32-39.
  18. North American Symptomatic Endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-453. https://doi.org/10.1056/NEJM199108153250701
  19. Fisher CM. Lacunes : small, deep cerebral infarcts. Neurology 1965;15:774-784. https://doi.org/10.1212/WNL.15.8.774
  20. Fisher CM, Curry HB. Pure motor hemiplegia from vascular origin. Arch of Neurol 1965;13 :30-34. https://doi.org/10.1001/archneur.1965.00470010034005
  21. Mohr JP, Caplan LR, Melski JW, et al. The Harvard Cooperative Stroke Registry : A prospective registry. Neurology 1978;28:754-762. https://doi.org/10.1212/WNL.28.8.754
  22. Wolf PA, Cobb JL, D'Agostino RB. Epidemiology of stroke. In: Barnett HJM, et al (eds). Stroke: Pathophysiology, Diagnosis and Management. New York: Chuchill Livingstone; 1992, p. 3-27.
  23. Kang JM, Rhee EJ, Jung CH, Chung PW, Moon HS, Kim YB, et al. Comparison of the prevalence of metabolic syndrome between patients with ischemic stroke and normal controls in a university hospital. Korean J Stroke 2005;7(1):55-62.
  24. Spence JD. Patients with atherosclerotic vascular disease: how low should plasma homocysteine levels go? Am J Cardiovasc Drugs. 2001;2(2) :85-89.
  25. McCully KS. Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol 1969;56:111-128.
  26. Lee DK, Choi HK, Son JC, Chung YJ, Kim BT, Kim KM. Serum homocysteine and its relevant factors among health screeners in a university hospital. J Korean Acad Fam Med 2005;26(11):671-679.
  27. Park JH, Shin DJ, Park HM, Lee YB, Shin WC. Association between metabolic syndrome and plasma homocysteine level in patients with ischemic stroke. J Korean Neurol Assoc 2005;23(1):9-14.
  28. Baek HK, Ko MM, Yu BC, Bang OS, Oh YS, Kim YJ, et al. The case-control study of risk factors of silent cerebral infarction. Korean J Orient Int Med 2007;28(4):850-862.
  29. Mohr JP. Lacunes. Stroke 1982;13:3-11. https://doi.org/10.1161/01.STR.13.1.3
  30. Postiglione A, Rubba P, De simone B, Patti L, Cicerano U, Mancini M. Carotid atherosclerosis in familial hypercholesterolemia. Stroke 1985;16 :658. https://doi.org/10.1161/01.STR.16.4.658
  31. Shin GM, Lee DK, Yi SD, Suh CK, Park YC. A study on risk factors of strokes. J Korean Neurol Assoc 1988;6(2):218-227.
  32. Terrence CF, Rao GR. Triglycerides as a risk factor in extracranial atherosclerotic cerebrovascular disease. Angiology 1983;34:452. https://doi.org/10.1177/000331978303400705
  33. Bu SA, Ko SG, Jung YS, Park KH. The case-control study on the risk of stroke in Korean adults -past medical history, life-style factors, serum lipid level, anthropometric indices-. Korean J Orient Int Med 2001;22(3) :423-430.
  34. Nagura J, Nakagawa Y, Miyanaga M, Matsuoka K, Hayashi K, Ozasa K, et al. Relationship between abdomial visceral fat and lacunar infarcts in Japanese men. Circ J 2004;68:982-987. https://doi.org/10.1253/circj.68.982
  35. Heyward VH, Wagner DR. Applied body composition assessment. 2nd ed. Campaign, IL: Human Kinetics; 2004, p. 40-43.
  36. Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in am elderly population. JAMA 1993;270:2693-2698. https://doi.org/10.1001/jama.1993.03510220049033