Homocysteine as a risk factor in type 1 and 2 diabetic patients with ischemic stroke

الملخص EN

Background: Stroke remains a major cause of mortality and morbidity worldwide.

The burden of stroke arises largely from the elderly population.

However, there remains a small but significant subset of younger patients with ischemic stroke, in whom conventional vascular risk factors play a smaller role.

Unusual causes of stroke, such as arterial dissection or thrombophilia, are more common, although the final cause may remain undetermined in 30%. It is important to search for modifiable risk factors in patients with diabetes mellitus.

The amino acid homo cysteine may be such a risk factor.

Objective: The aim of the present study is to identify the relationship between plasma homo cysteine level and the risk of ischemic stroke in diabetic patients.

Study Design: The present study was conducted on 40 patients with diabetes mellitus (25-75 years) age, 16 females, 24 males, twenty healthy subjects were included as controls aged (43-67 years), 8 females and 12 males. Patients were classified into 2 groups Gr I: 20 patients with type 1DM Gr II: 20 patients with type 2 DM For all subjects, full history taking, thorough clinical examination, fasting and post prandial blood glucose, HbA1, renal function, total cholesterol HDL cholesterol, triglycerides, vitamin B12level, folic acid level, and, fasting plasma homo cysteine were assayed.

Brain imaging was done to diagnose ischemic stroke. RESULTS: - Higher values of homo cysteine were found in the total groups of patients with diabetes 84 mellitus than control subjects. Homo cysteine As A Risk Factor Salwa Seddik, et al Statistical significant elevation of homo cysteine levels in GrI (14.3 + 3.2 μmol / L) than control subjects (8.9 + 0.7 μmol /L) (P< 0.05) - Statistical significant elevation of homo cysteine levels in GrII (12.7 + 1.7 μmol /L) than control subjects (8.9 + 0.7 μmol/L) (P<0.05). - Non-significant elevation of homo cysteine in males than females in GrI (14.7 + 3.9 vs 13.8.+.2.2.μmol / L) P>0.05 Non-significant elevation of homo cysteine in males than females in GrII (13.3 + 1.7 vs 1+ 11.6 μmol /L) P>0.05 Statistical significant elevation of homo cysteine levels in GrI diabetic patients with ischemic stroke (9 + 0.53 μmol / L) than patients without stroke (8.8 + 0.93 μmol / L) P>0.05 Statistical significant elevation of homo cysteine levels in Gr II diabetic patients with ischemic stroke (15.9 + 3.6 μmol / L) than patients without stroke (12.7 + 1.8 μmol / L) P<0.05 There is significant elevation of homo cysteine levels in hypertensive GrI diabetic Patients (15.4 + 4.03 μmol / L) than non-hypertensive patients (13.4 + 2.1 μmol/L) P<0.05 - There is significant elevation of homo cysteine levels in hypertensive GrII diabetic patients (13.08 + 1.5 μmol /L) than non-hypertensive patients (12.5 + 1.8 μmol/L) P<0.05 On correlating homo cysteine levels with other studied parameters in GrI: We found significant correlation between homo cysteine level and duration of diabetes mellitus (r = 0.09), BMI (r = 0.50), FBS (r = 0.27).

HDL (r = 0.16), LDL (r = 0.29) .(TG (r=0.224 - Highly significantly correlation between homo cysteine level and HbA1 (r = 0.38). Highly significant inverse correlation between homo cysteine level and serum folic acid level B12 level (r=-0.37).

On correlating homo cysteine level and all studied parameters in GrII: We found statistical significant correlation between homo cysteine levels and duration of diabetes mellitus (r=0.25), BMI (r=0.204) FBS (r=0.349), TG (r=0.139), HDL (r=0.26), LDL (r=0.28) HbA1 (r=0.149). Highly significant correlation between homo cysteine level and age of patients .(r=0.365) Significant inverse correlation between homo cysteine level and serum B12 level (r=0.16). - Highly significant inverse correlation between homo cysteine level and serum folic acid level (r=-0.96). Conclusion: High homo cysteine levels in diabetic patients were associated with high prevalence of ischemic strokes.

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