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Homocysteine and small vessel stroke: A mendelian randomization analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Nobels Vag 13, Stockholm, Sweden.ORCID iD: 0000-0003-0118-0341
Univ Cambridge, Dept Clin Neurosci, Stroke Res Grp, Cambridge, England.
Univ Cambridge, Dept Clin Neurosci, Stroke Res Grp, Cambridge, England.
2019 (English)In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 85, no 4, p. 495-501Article in journal (Refereed) Published
Abstract [en]

Objective

Trials of B vitamin therapy to lower blood total homocysteine (tHcy) levels for prevention of stroke are inconclusive. Secondary analyses of trial data and epidemiological studies suggest that tHcy levels may be particularly associated with small vessel stroke (SVS). We assessed whether circulating tHcy and B vitamin levels are selectively associated with SVS, but not other stroke subtypes, using Mendelian randomization.

Methods

We used summary statistics data for single-nucleotide polymorphisms (SNPs) associated with tHcy (n = 18), folate (n = 3), vitamin B-6 (n = 1), and vitamin B-12 (n = 14) levels, and the corresponding data for stroke from the MEGASTROKE consortium (n = 16,952 subtyped ischemic stroke cases and 404,630 noncases).

Results

Genetically predicted tHcy was associated with SVS, with an odds ratio of 1.34 (95% confidence interval [CI], 1.13-1.58; p = 6.7 x 10(-4)) per 1 standard deviation (SD) increase in genetically predicted tHcy levels, but was not associated with large artery or cardioembolic stroke. The association was mainly driven by SNPs at or near the MTHFR and MUT genes. The odds ratios of SVS per 1 SD increase in genetically predicted folate and vitamin B-6 levels were 0.49 (95% CI, 0.34-0.71; p = 1.3 x 10(-4)) and 0.70 (95% CI, 0.52-0.94; p = 0.02), respectively. Genetically higher vitamin B-12 levels were not associated with any stroke subtype.

Interpretation

These findings suggest that any effect of homocysteine-lowering treatment in preventing stroke will be confined to the SVS subtype. Whether genetic variants at or near the MTHFR and MUT genes influence SVS risk through pathways other than homocysteine levels and downstream effects require further investigation. Ann Neurol 2019;85:495-501

Place, publisher, year, edition, pages
2019. Vol. 85, no 4, p. 495-501
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-383517DOI: 10.1002/ana.25440ISI: 000466415500006PubMedID: 30785218OAI: oai:DiVA.org:uu-383517DiVA, id: diva2:1316203
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00123EU, Horizon 2020, 667375Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2019-05-16Bibliographically approved

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