vitamin-b-12 and Cerebrovascular-Disorders

We reviewed reasons for the high cardiovascular risk (CVD) of patients with chronic kidney disease (CKD), and explored alternatives to treatment of traditional risk factors to reduce CVD in CKD.. Besides traditional risk factors, patients with CKD are exposed to uremic toxins of two kinds: systemically derived toxins include asymmetric dimethylarginine (ADMA), total homocysteine (tHcy), thiocyanate, tumor necrosis factor alpha, and interleukin 6. Gut-derived uremic toxins (GDUT), products of the intestinal microbiome, include hippuric acid, indoxyl sulfate, p-cresyl sulfate, p-cresyl glucuronide, phenylacetylglutamine, and trimethylamine N-oxide (TMAO). Cyanocobalamin is toxic in patients with CKD. Approaches to reducing plasma levels of these uremic toxins would include diet to reduce GDUT, kidney transplantation, more intensive dialysis, and vitamin therapy to lower tHcy with methylcobalamin rather than cyanocobalamin. The high CVD risk in CKD requires consideration of therapies beyond treatment of traditional risk factors.

Topics: Cardiovascular Diseases; Cerebrovascular Disorders; Humans; Renal Insufficiency, Chronic; Toxins, Biological; Vitamin B 12

Topics: Age Factors; Animals; Blood Coagulation; Cerebrovascular Disorders; Chemical and Drug Induced Liver Injury; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Coronary Disease; Folic Acid; Humans; Hypertension; Metabolism; Myocardial Infarction; Neoplasms; Progestins; Skin; Smoking; Teratogens; Thromboembolism; Time Factors; Vitamin B 12

In the initial B-proof, we found inconsistent results of B vitamin supplementation. However, the debate regarding the effects of B vitamins on age-related diseases continues. Therefore, our aim was to investigate the long-term effects (5-7 years follow-up) of an intervention with folic acid and vitamin-B12 supplementation on fracture and cardiovascular disease risk.. Extended follow-up of the B-PROOF trial, a multi-center, double-blind randomized placebo-controlled trial designed to assess the effect of 2-3 years daily supplementation with folic acid (400 μg) and vitamin-B12 (500 μg) versus placebo (n = 2,919). Primary outcome was verified self-reported fracture incidence and secondary outcomes were self-reported cardiovascular endpoints, which were collected through a follow-up questionnaires Proportional hazard analyses was used for the effect of the intervention on risk of fracture(s) and logistic regression for the effect of the intervention on risk of cardiovascular disease.. A total of 1,298 individuals (44.5%) participated in the second follow-up round with median of 54 months [51-58], (n = 662 and n = 636, treatment versus placebo group). Median age at baseline was 71.0 years [68.0-76.0] for both groups. No effect was observed of the intervention on osteoporotic fracture or any fracture risk after a follow-up (HR: 0.99, 95% CI: 0.62-1.59 and HR: 0.77; 95% CI: 0.50-1.19, respectively), nor on cardiovascular or cerebrovascular disease risk (OR: 1.05; 95%CI: 0.80-1.44 and OR: 0.85; 95%CI: 0.50-1.45, respectively). Potential interaction by baseline homocysteine concentration was observed for osteoporotic- and any fracture (p = 0.10 and 0.06 respectively), which indicated a significantly lower risk of any fracture in the treatment group with higher total homocysteine concentrations (>15.1 μmol/l). No age-dependent effects were present.. This study supports and extends previous null-findings of the B-PROOF trial and shows that supplementation of folic acid and vitamin-B12 has no effect on fracture risk, nor on cardiovascular disease in older individuals over a longer follow-up period. However, B-vitamin supplementation may be beneficial in reducing fractures in individuals with high total homocysteine concentrations, a finding which needs to be replicated.

Topics: Aged; Cardiovascular Diseases; Cerebrovascular Disorders; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Follow-Up Studies; Fractures, Bone; Homocysteine; Humans; Male; Odds Ratio; Osteoporotic Fractures; Placebos; Risk Factors; Vitamin B 12

Elevated homocysteine has been identified as an independent risk factor for cardiovascular and cerebrovascular disease. Although multivitamin use has been associated with low plasma homocysteine concentrations in several observational studies, no clinical trials have been conducted using multivitamin/mineral supplements to lower homocysteine. We determined whether a multivitamin/mineral supplement formulated at about 100% Daily Value will further lower homocysteine concentration and improve B-vitamin status in healthy older adults already consuming a diet fortified with folic acid. In this randomized, double-blind, placebo-controlled trial, 80 free-living men and women aged 50-87 y with total plasma homocysteine concentrations of > or =8 micromol/L received either a multivitamin/mineral supplement or placebo for 56 d while consuming their usual diet. After the 8-wk treatment, subjects taking the supplement had significantly higher B-vitamin status and lower homocysteine concentration than controls (P: < 0.01). Plasma folate, pyridoxal phosphate (PLP) and vitamin B-12 concentrations were increased 41.6, 36.5 and 13.8%, respectively, in the supplemented group, whereas no changes were observed in the placebo group. The mean homocysteine concentration decreased 9.6% in the supplemented group (P: < 0.001) and was unaffected in the placebo group. There were no significant changes in dietary intake during the intervention. Multivitamin/mineral supplementation can improve B-vitamin status and reduce plasma homocysteine concentration in older adults already consuming a folate-fortified diet.

Topics: Aged; Aged, 80 and over; Aging; Cardiovascular Diseases; Cerebrovascular Disorders; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Food, Fortified; Homocysteine; Humans; Male; Middle Aged; Minerals; Nutritional Status; Pyridoxal Phosphate; Risk Factors; Vitamin B 12; Vitamin B Complex; Vitamins

It was the aim of this study to determine the associations of clinical and laboratory data with plasma homocyst(e)ine levels in patients with transient ischemic attack (TIA) or minor stroke (MS), with special reference to their 677C to T mutation status in the 5,10-methylenetetrahydrofolate reductase (5,10-MTHFR) gene. Seventy-six patients with TIA or MS were investigated at least 3 months after their (last) clinical event. By means of univariate analysis, significant correlations of homocyst(e)ine levels with male gender (P<0.02), age (P<0.0005), creatinine levels (P<0.0002), folate levels (inversely, P<0.05), and alcohol use (P<0.02) were found, but not with vitamin B12 levels. Multivariate regression analysis, including age, creatinine levels, and folate levels as independent variables, revealed age (P<0.01) and creatinine levels (P<0.02) to be significantly correlated with homocyst(e)ine levels. After adjustment for age, creatinine levels and homocyst(e)ine levels remained significantly correlated to each other (P<0.005), whereas the relation between folate levels and homocyst(e)ine levels was no longer significant (P=0.10). Mutation-positive patients exhibited moderately and statistically non-significantly higher homocyst(e)ine levels than mutation-negative patients, particularly those who were homozygous positive. Homocyst(e)ine levels were closely correlated with creatinine levels (P<0.0002) and with folate levels (inversely, P<0.05), but only in mutation-positive and not in mutation-negative patients. Homozygous positive, heterozygous positive, and mutation-negative patients did not differ with respect to clinical and laboratory data concerning 'risk factors for stroke' or co-existing vascular disease. In conclusion, the associations of creatinine levels and, inversely, of folate levels with plasma homocyst(e)ine levels in patients with TIA or MS are dependent on the 5,10-MTHFR mutation status. Significant correlations between these variables were found only in mutation-positive but not in mutation-negative patients.

Topics: 5,10-Methylenetetrahydrofolate Reductase (FADH2); Adult; Aged; Aged, 80 and over; Analysis of Variance; Cerebrovascular Disorders; Female; Folic Acid; Homocysteine; Humans; Ischemic Attack, Transient; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Mutation; Oxidoreductases; Risk Factors; Vitamin B 12

This study was conducted to investigate the role of different homocysteine metabolism-related vitamin (HMRV) levels in the correlation between hyperhomocysteinemia (HHCY) and ischemic stroke (IS) subtypes. Three hundred and forty-eight IS patients manifesting different vascular subtypes were subclassified on the basis of HMRV deficiencies. Correlation between HHCY and IS subtypes was investigated in all the subgroups. In this study, HHCY was significantly correlated with the IS subtypes in large artery atherosclerosis (OR 1.126, 95%CI: 1.051 ~ 1.206, P = 0.001) and small artery occlusion (OR 1.105, 95%CI: 1.023 ~ 1.193, P = 0.012). Subgroup analysis revealed a correlation between HHCY and IS subgroup (OR 1.201, 1.178, 95%CI: 1.081 ~ 1.334, 1.058 ~ 1.313, P = 0.001, P = 0.003, respectively) in HMRV deficiency, but not significantly with the IS subgroup in normal HMRV levels. Serum vitamin B12 concentrations are inversely correlated with both IS subtypes in HMRV deficiency subgroups (OR 0.992, 0.995, 95%CI: 0.987 ~ 0.996, 0.991 ~ 0.999, P < 0.001, P = 0.007, respectively), which may contribute to HHCY incidence in these populations. The correlation between HHCY and IS subtypes is affected by HMRV levels in this case-control study. Our findings are helpful to understand the inconsistency in prior homocysteine studies. Serum vitamin B12 levels may play a critical role in HHCY incidence in this Chinese population.Cerebrovascular disease has emerged as the leading cause of disability and mortality in both urban and rural areas of China (Neurology branch of Chinese Medical Association 2015). Ischemic stroke (IS) constitutes 60% to 80% of all cerebrovascular disease (Neurology branch of Chinese Medical Association 2014). Among a variety of risk factors, hyperhomocysteinemia (HHCY) has been closely correlated with IS due to intracranial small-vessel disease and extracranial large-artery disease (Selhub et al. 1995; Eikelboom et al. 2000; Alvarez et al. 2012; Jeon et al. 2014). However, the failure to lower homocysteine (HCY) via homocysteine metabolism-related vitamin (HMRV, including folic acid and vitamin B12 but not vitamin B6 in this study) supplementation to reduce stroke morbidity questions the role of HCY as a risk factor for stroke (Lonn et al. 2006; Hankey et al. 2010). Theoretically, HMRV supplementation merely lowers the incidence of stroke induced by HHCY resulting from HMRV deficiency, whereas HHCY-induced stroke concomitant with normal HMRV levels ma

Topics: Aged; Aged, 80 and over; Asian People; Case-Control Studies; Cerebrovascular Disorders; China; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Intracranial Arteriosclerosis; Kidney; Male; Middle Aged; Retrospective Studies; Stroke; Vitamin B 12

We examined whether using a medical food therapy for hyperhomocysteinemia (HHcy) in patients with Alzheimer's disease (AD) or cognitive impairment due to cerebrovascular disease (CVD) with Cerefolin®/CerefolinNAC® (CFLN: L-methylfolate, methylcobalamin, and N-acetyl-cysteine) slowed regional brain atrophy. Thirty HHcy patients with AD and related disorders (ADRD) received CFLN (HHcy+CFLN: duration [μ ±  σ] = 18.6±16.1 months); a sub-sample of this group did not receive CFLN for varying periods of time (HHcy+NoCFLN: duration [μ ±  σ] = 12.6±5.6 months). Thirty-seven NoHHcy patients with ADRD did not receive CFLN (NoHHcy+NoCFLN: duration [μ ±  σ] = 13.3±17.7 months). No participant took supplemental B vitamins. Regional brain volumes were measured at baseline and end of study, and covariate-adjusted rates of hippocampal, cortical, and forebrain parenchymal (includes white matter) atrophy were predicted. The HHcy+CFLN group's hippocampal and cortical atrophy adjusted rates were 4.25 and 11.2 times slower than those of the NoHHcy+NoCFLN group (p < 0.024). The HHcy+CFLN group's forebrain parenchyma atrophy rate was significantly slower only for CVD; the rate of slowing was proportional to the degree of homocysteine lowering (p < 0.0001). CFLN was associated with significantly slowed hippocampal and cortical atrophy rates in ADRD patients with HHcy, and forebrain parenchymal atrophy rates in CVD patients with HHcy. The present results should be further validated.

Topics: Acetylcysteine; Aged; Aged, 80 and over; Alzheimer Disease; Atrophy; Cerebral Cortex; Cerebrovascular Disorders; Dietary Supplements; Female; Humans; Hyperhomocysteinemia; Male; Middle Aged; Tetrahydrofolates; Vitamin B 12; Vitamin B Complex; White Matter

To describe the mortality and fatality of diabetes and assess their relationship with the level of red blood cell (RBC) folate.. We analyzed the data of 526 adults with diabetes who participated in the National Health and Nutrition Examination Survey (1991-1994) as the baseline examination, and were followed up through December 31, 2006. Estimates of the hazard ratios (HRs) of selected death causes for individuals with different levels of RBC folate were obtained from Cox proportional hazards regression. A total of 295 deaths were recorded by the end of a 15-year follow-up with a mortality rate of 58.48 per 1000 person year (py). Diabetes was listed as a contributing cause for 136 deaths, accounting for 46.1% of the total deaths with a fatality rate 26.96 per 1000 py. Mortality rate for all-cause in the group with upper quartile of RBC folate was almost twice as high as that among the group with lower quartile, 82.75 vs. 44.10 per 1000 py. After adjusting for covariates, including serum concentration of vitamin B12, cotinine, homocysteine and the history of cardio-cerebral vascular diseases assessed at the baseline, the HRs for dying from any causes were 1.00 (reference), 1.82 (95% CI = 1.25-2.66) and 2.10 (1.37-3.20) among diabetic adults with lower, intermediate, and upper quartiles of RBC folate.. Diabetes was listed as a contributing cause for less than half of the deaths among adults with diabetes after 15+ years of follow-up; high RBC folate concentration was associated with an elevated risk of death among adults with diabetes.

Topics: Aged; Cause of Death; Cerebrovascular Disorders; Cohort Studies; Cotinine; Diabetes Mellitus, Type 2; Dietary Supplements; Dose-Response Relationship, Drug; Erythrocytes; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Male; Middle Aged; Nutrition Surveys; Proportional Hazards Models; Risk Factors; Socioeconomic Factors; Vitamin B 12

Hyperhomocysteinemia is associated with cerebral small vessel disease (SVD). We examined the relationship between homocysteine and 1) volumetric measure of white matter change (WMC), 2) silent brain infarcts, 3) cerebral atrophy on MRI and 4) cognition on a consecutive cohort of patients with stroke associated with SVD.. Fifty-seven patients consecutively admitted to the Acute Stroke Unit in a university hospital due to stroke associated with SVD were recruited and assessed three months after the stroke. Non-fasting homocysteine was obtained. Using MRI, the number of infarcts, volume of WMC and cerebral atrophy were measured. General cognitive functions were assessed using the Mini Mental State Examination and Alzheimer's disease Assessment Scale. Mattis Dementia Rating Scale - Initiation/Perseveration subset was used to assess executive cognitive functions.. Hyperhomocysteinemia (> or = 14.88 micromol/L) significantly accounted for the volume of WMC on MRI in a multivariate stepwise regression model (adjusted R(2)=0.058, p <0.05) after adjustment for age and folate level. Patients in the highest quartile of WMC volume had significantly higher levels of homocysteine than those in lowest quartile (p <0.001). No significant relationship was found between homocysteine and silent brain infarcts, cerebral atrophy and performance on psychometric tests.. Hyperhomocysteinemia is associated with volumetric measure of WMC among patients with SVD. The role of homocysteine in the development of silent brain infarcts and cerebral atrophy as previously reported cannot be ascertained in this study. No direct relationship was found between homocysteine and cognitive functions.

Topics: Aged; Brain; Cerebrovascular Disorders; Cognition Disorders; Cohort Studies; Creatinine; Female; Homocysteine; Humans; Hyperhomocysteinemia; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychometrics; Regression Analysis; Risk Factors; Stroke; Vitamin B 12

Cerebrovascular small vessel disease is now believed to be the major source of vascular burden of the brain. Cerebrovascular small vessel disease and Alzheimer's disease appear to represent pathophysiologic and clinical continua, rather than dichotomous entities. It appears that common etiopathologic mechanisms underlie the clinical presentation of both of these conditions. Therefore, the staging procedures that have been developed for the clinical continuum of age-associated memory impairment, mild cognitive impairment, and the progressive dementia of Alzheimer's disease appear to be applicable for the same continua in cerebrovascular small vessel disease. Although temporal and prognostic aspects have been studied for the Alzheimer's-related portions of this clinical staging continuum, they remain to be elucidated for cerebrovascular small vessel disease.

Topics: Aged; Alzheimer Disease; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Cognition Disorders; Cost of Illness; Follow-Up Studies; Humans; Neuropsychological Tests; Prospective Studies; Severity of Illness Index; Vitamin B 12

Cobalamin (B12) and folate deficiency is related to both increased erythrocyte mean cellular volume (MCV) and raised serum total homocysteine (tHcy) values. Furthermore, there are indications that B12 and folate serum values do not represent the tissue status of the two vitamins exactly. Therefore, a direct relationship between MCV and tHcy, if demonstrated, could support the hypothesis that tHcy is a better indicator for the cited vitamin status than the serum levels of B12 and folate. We studied MCV, gamma glutamyl transferase (GGT), serum B12, folate and tHcy values in 200 hospitalized patients. There was a significant correlation of MCV with GGT (r = 0.266, P < 0.001) and with tHcy (r = 0.248, P < 0.001), but not with serum B12 and folate. Stepwise multiple linear regression with MCV as dependent and GGT, B12, folate and tHcy as independent variables, respectively, revealed significant associations of MCV with GGT (B = 2.18, 95% CI 0.95-3.42, P = 0.001) and tHcy (B = 3.33, 95% CI 1.26-5.39, P = 0.002). By removing tHcy from this model, serum B12 became a significant predictor of MCV (B = -1.70, 95% CI -3.25 to -0.15, P = 0.032). Serum folate was not significantly associated with MCV in multivariate analysis. In conclusion, the present study confirms indications that serum B12 and folate values lack clinical sensitivity and specificity in diagnosing vitamin deficiency states by showing MCV was better associated to tHcy, than to B12 or folate serum levels. This observation demonstrates that tHcy may be useful in diagnosing patients with B12 and/or folate deficiency.

Topics: Cerebrovascular Disorders; Erythrocyte Volume; Female; Folic Acid; Hemodynamics; Hemoglobins; Homocysteine; Humans; Male; Middle Aged; Vascular Diseases; Vitamin B 12

The elderly are known to have higher rates of low and subnormal vitamin B12 levels than younger persons. Vitamin B12 deficiency has been extensively studied in the elderly, but primarily in outpatient settings. There is a paucity of data regarding the prevalence of low and low-normal B12 in frail, hospitalized, elderly patients, and its implications. Additionally, there is little information regarding vitamin B12 status in Israeli elders.. The objectives of the study were to estimate the prevalence of low and borderline vitamin B12 levels among frail, hospitalized, elderly patients, and their clinical implications.. We conducted a chart review, using a retrospective cohort design. The participants were 895 patients admitted to Harzfeld Medical Center in Gedera, Israel. Records were abstracted for vitamin B12 and Folic Acid levels, gastric disease, and outcomes including death, cognitive impairment and neurologic disease.. Six hundred and forty patients were eligible for the study. In 15% of the patients, vitamin B12 level was in the low range (<150pmol/L) and in 25% in the low-normal range (150-250pmol/L). Gastric disease and antacid use were not associated with the vitamin B12 status. Mortality was higher in the high vitamin B12 group (p=0.02), perhaps reflecting a selection toward higher acuity in this group. Cerebrovascular disease was more common in patients with lower vitamin B12 levels (p=0.046).. Forty percent of hospitalized elderly patients have low or borderline serum levels of vitamin B12, which may contribute to cerebrovascular disease and cognitive decline.

Topics: Aged; Cerebrovascular Disorders; Cognition Disorders; Cohort Studies; Female; Folic Acid; Health Services for the Aged; Hospitalization; Humans; Israel; Male; Prevalence; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia is a risk factor for obstructive large-vessel disease. Here, we studied plasma concentrations of homocysteine and vitamins in patients suffering from subcortical vascular encephalopathy (SVE), a cerebral small-vessel disease leading to dementia. These results were compared to the homocysteine and vitamin plasma concentrations from patients with cerebral large vessel disease and healthy control subjects. Plasma concentrations of homocysteine, vascular risk factors and vitamin status (B6, B12, folate) were determined in 82 patients with subcortical vascular encephalopathy, in 144 patients with cerebral large-vessel disease and in 102 control subjects. Patients with SVE, but not those with cerebral large-vessel disease, exhibited pathologically increased homocysteine concentrations in comparison with control subjects without cerebrovascular disease. Patients with SVE also showed lower vitamin B6 values in comparison to subjects without cerebrovascular disease. Logistic regression analysis showed that homocysteine is associated with the highest risk for SVE (odds ratio 5.7; CI 2.5-12.9) in comparison to other vascular risk factors such as hypertension, age and smoking. These observations indicate that hyperhomocysteinemia is a strong independent risk factor for SVE.

Topics: Aged; Arteries; Case-Control Studies; Cerebrovascular Disorders; Dementia, Vascular; Female; Folic Acid; Homocysteine; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Risk Factors; Vitamin B 12; Vitamin B 6

Elevated homocyst(e)ine levels are associated with an increased risk of vascular disease, particularly aorto-iliac, coronary and cerebrovascular disease. In patients with confirmed disease, plasma homocyst(e)ine is a strong predictor of death. In addition to B vitamins, folic acid and certain genotypes, renal function is an independent determinant of plasma homocyst(e)ine level. There also may be a polygenic component contributing to elevated homocyst(e)ine levels in confirmed vascular disease. Possible mechanisms of homocyst(e)ine-induced vascular change include proliferation of vascular smooth muscle cells, endothelial cell dysfunction and a procoagulant state. The definition of hyperhomocyst(e)inemia is based on arbitrary cut-points (eg, the 90th percentile). In most populations, this is approximately 15 microM/L. Patients with hyperhomocyst(e)inemia should be treated with at least 400 micrograms of folic acid per day. Alternative treatments are vitamin B6 and B12 supplementation, although optimal doses have yet to be identified.

Topics: Animals; Cardiovascular Diseases; Cerebrovascular Disorders; Coronary Disease; Cricetinae; Female; Folic Acid; Humans; Hyperhomocysteinemia; Male; Middle Aged; Pyridoxine; Risk Factors; Vitamin B 12

A prospective population study of women in Gothenburg, Sweden was started in 1968-69 and comprised 1462 women aged 38, 46, 50, 54, or 60 years at baseline. Follow-up studies were carried out in 1974-75, 1980-81, and 1992-93. The baseline study included an extensive medical and dental examination. Serum mercury concentration (beta-HG) was determined in deep-frozen samples from all participants in 1968-69 and in a random subsample of sera from participants in 1980-81, about 20 years after the baseline examination. S-Hg was statistically significantly correlated with number of amalgam fillings at both examinations. Of 30 defined symptoms and 4 different clusters of symptoms, no one was independently correlated with S-Hg measured in the samples from 1968-69, while there was a negative statistically significant correlation with over-exertion and poor appetite in 1980-81. Blood hemoglobin and serum B-12 concentrations in 1968-69 were statistically significantly and positively correlated with S-Hg, while erythrocyte sedimentation rate and the serum concentrations of potassium and triglycerides were significantly and negatively correlated with S-Hg, also after including potential confounders. Blood hematocrit examined in 1980-81 was negatively correlated with S-Hg. When including potential confounders, serum IgA was also statistically significantly correlated with S-Hg, but not in univariate analysis. No statistically significant correlation was observed between S-Hg, on the one hand, and the incidence of diabetes, myocardial infarction, stroke, or cancer on the other, while a statistically significant negative correlation was observed with overall mortality when age and education were included as background variables. There were some correlations between biological variables and S-Hg, probably of no negative clinical significance, and we conclude that there is no association between disease and S-Hg on a population basis in middle-aged and older women.

Topics: Adult; Age Factors; Aged; Blood Sedimentation; Cerebrovascular Disorders; Confounding Factors, Epidemiologic; Dental Amalgam; Dental Restoration, Permanent; Diabetes Mellitus; Educational Status; Epidemiology; Fatigue; Feeding and Eating Disorders; Female; Follow-Up Studies; Hematocrit; Hemoglobins; Humans; Immunoglobulin A; Longitudinal Studies; Mercury; Middle Aged; Myocardial Infarction; Neoplasms; Potassium; Prospective Studies; Survival Rate; Sweden; Triglycerides; Vitamin B 12

It has been reported that patients with vascular disease seem to increase their concentration of plasma homocysteine after the acute episode, whereas reexamined control subjects do not change their concentration of plasma homocysteine over time. Since the main determinants of plasma homocysteine are serum cobalamin, blood folate and serum creatinine we measured these quantities in 20 control subjects and 49 stroke patients in the acute phase and at reexamination 1.5-2 years after acute stroke onset. There were no significant differences between the levels of blood folate, serum cobalamin and serum creatinine in the acute and convalescent phase of all 49 stroke patients. However, we noted a significant decrease of blood folate concentrations in a subgroup of patients (n = 25) who had increased plasma homocysteine concentrations. Thus the increase in plasma homocysteine concentrations in this group of patients may partly be caused by a marginal folate deficiency.

Topics: Aged; Case-Control Studies; Cerebrovascular Disorders; Creatinine; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Time Factors; Vitamin B 12

Elevated plasma homocysteine levels are recognized as an independent risk factor for atherosclerotic disease. It is not known (1) whether the severity of atherosclerotic disease is related to hyperhomocyst(e)inemia or (2) whether any such relation differs between fasting and post-methionine loading plasma homocysteine levels. Therefore, in 171 consecutive patients under 55 years of age with first symptoms of lower-limb disease, we examined the relation between severity of atherosclerosis and plasma homocysteine concentration. Severity of atherosclerotic disease was estimated from the prevalence of coronary artery disease and cerebrovascular disease and from the angiographic extent of lower-limb disease. Plasma homocysteine was measured after a period of fasting and in response to methionine loading (0.1 g/kg). In multivariate analysis, the prevalence of coronary artery disease plus cerebrovascular disease was related to both fasting and postmethionine homocysteine levels (odds ratio [OR] for the upper quartile versus the lower three quartiles, 2.8, 95% confidence interval [CI], 1.1 to 7.5; and OR 3.0, 95% CI, 1.1 to 7.8, respectively). The extent of lower-limb disease was weakly related to the fasting homocysteine level (partial correlation coefficient, .12; P = .17) and more strongly related to the postmethionine homocysteine level (partial correlation coefficient, .25; P = .003). These relations tended to be more pronounced in women than in men. They were independent of age, total serum cholesterol, blood pressure, and smoking habit. We concluded that the severity of atherosclerotic disease in young patients with lower-limb atherosclerotic disease is associated with high postmethionine and fasting homocysteine concentrations.

Topics: Adult; Arteriosclerosis; Cerebrovascular Disorders; Coronary Disease; Fasting; Female; Folic Acid; Homocysteine; Humans; Leg; Male; Methionine; Middle Aged; Pyridoxine; Risk Factors; Vitamin B 12

Moderate hyperhomocysteinaemia is a frequent finding in atherothrombotic cerebrovascular disease. This study confirms and extends this observation. Hyperhomocysteinaemia was present in 57 of 142 survivors with stroke (40%) and in four of 66 controls (6%). Plasma homocysteine concentrations were increased not only in carotid artery disease or lucunar stroke but also in haemorrhagic or embolic strokes. Homocysteine values were unrelated to the presence of hypertension, smoking, or hypercholesterolaemia, or to the concentrations of blood glucose, glycosylated haemoglobin, and plasma fibrinogen. Multiple regression analysis of the patient data showed that about 40% of the variation in plasma homocysteine concentrations could be predicted by the values for the homocysteine metabolism cofactors, blood folate and plasma pyridoxal 5-phosphate and by renal function as reflected in the values for serum creatinine. In patients, urine excretion of homocysteine per unit creatinine was significantly increased and strongly correlated both to the plasma homocysteine concentration and to the values for blood folate, plasma pyridoxal 5-phosphate, and serum vitamin B12. We conclude that moderate hyperhomocysteinaemia is frequently present in cases of stroke, is independent of other stroke risk factors or the type of stroke, and is partly related to renal function and the concentrations of homocysteine metabolism cofactors.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Cerebrovascular Disorders; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Pyridoxal Phosphate; Risk Factors; Vitamin B 12

EEGs were recorded in 54 patients with pernicious anemia. Six patients without nervous system involvement had normal EEGs, 10 patients with spinal cord or peripheral nervous system involvement had normal or minimally abnormal EEGs, 17 of 19 patients with evidence of mental dysfunction had abnormal EEGs with the most consistent finding being an excess of theta slowing, and 19 patients with pernicious anemia and other neurologic diseases showed EEG findings reflecting the complicating disease process. In general, the EEG abnormalities in patients with pernicious anemia correlated well with the presence of cerebral dysfunction but not with the degree of anemia. The EEG was also a good indicator for detecting and confirming other intracranial disease processes unrelated to pernicious anemia.

Topics: Adult; Aged; Anemia, Pernicious; Beta Rhythm; Central Nervous System Diseases; Cerebrovascular Disorders; Electroencephalography; Female; Hemoglobinometry; Humans; Male; Mental Disorders; Middle Aged; Theta Rhythm; Vitamin B 12

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Anti-Bacterial Agents; Arteriosclerosis; Basilar Artery; Cerebrovascular Disorders; Chronic Disease; Deoxyribonucleases; Diabetic Neuropathies; Diuretics; Facial Nerve; Facial Paralysis; Female; Herpes Zoster; Humans; Hypertension; Ischemia; Male; Middle Aged; Physical Therapy Modalities; Prednisolone; Recurrence; Tonsillitis; Vertebral Artery; Vitamin B 12

Topics: Aged; Aging; Cerebrovascular Disorders; Dietary Proteins; Glucose; Hemodynamics; Humans; Infections; Ischemic Attack, Transient; Mental Disorders; Niacinamide; Oxygen Consumption; Pyridoxine; Thiamine; Vitamin B 12

Topics: Adult; Aged; Arteriosclerosis; Cerebrovascular Disorders; Dementia; Female; Hemiplegia; Humans; Hypertension; Male; Middle Aged; Nucleotides; Pyridoxine; Taurine; Vitamin B 12

Topics: Adolescent; Adult; Aged; Blood; Cerebrovascular Disorders; Cobalt Isotopes; Coronary Disease; Female; Glomerular Filtration Rate; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Pre-Eclampsia; Pregnancy; Statistics as Topic; Uric Acid; Vitamin B 12

Topics: Autonomic Nervous System Diseases; Barbiturates; Biomedical Research; Blood Chemical Analysis; Carbon Monoxide Poisoning; Cerebrovascular Disorders; Chemical Phenomena; Chemistry; Humans; Hydroxocobalamin; Mental Disorders; Neuralgia; Neuritis; Neurology; Pharmacology; Poisoning; Vitamin B 12

Topics: Brain Ischemia; Cerebral Infarction; Cerebrovascular Disorders; Diphenhydramine; Drug Therapy; Histamine H1 Antagonists; Humans; Ischemic Attack, Transient; Procaine; Thiamine; Toxicology; Vitamin B 12