Relationship between homocysteine levels and post-stroke cognitive impairment in female and male population: from a prospective multicenter study

Runzhi Li; Haoyi Weng; Yuesong Pan; Xia Meng; Xiaoling Liao; Mengxing Wang; Yuan Zhang; Yi Sui; Lijun Zuo; Yanli Wang; Ziyan Jia; Mengfan Sun; Wenyi Li; Yaou Liu; Jinglong Chen; Jun Xu; Yongjun Wang

doi:10.2478/jtim-2021-0035

Relationship between homocysteine levels and post-stroke cognitive impairment in female and male population: from a prospective multicenter study

J Transl Int Med. 2021 Dec 31;9(4):264-272. doi: 10.2478/jtim-2021-0035. eCollection 2021 Dec 1.

Authors

Runzhi Li^{1

2}, Haoyi Weng^{3

4

5}, Yuesong Pan^{1

6}, Xia Meng^{1

6}, Xiaoling Liao^{1

6}, Mengxing Wang^{1

6}, Yuan Zhang^{1

6}, Yi Sui⁷, Lijun Zuo^{1

6}, Yanli Wang^{1

6}, Ziyan Jia^{1

6}, Mengfan Sun^{1

6}, Wenyi Li^{1

6}, Yaou Liu², Jinglong Chen⁸, Jun Xu^{6

9}, Yongjun Wang^{1

6}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
² Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
³ Bioinformatics Department, Shenzhen WeGene Clinical Laboratory, Shenzhen 518118, Guangdong Province, China.
⁴ WeGene, Shenzhen Zaozhidao Technology Co. Ltd, Shenzhen 518118, Guangdong Province, China.
⁵ Hunan Provincial Key Lab on Bioinformatics, School of Science and Engineering, Central South University, Changsha 410083, Hunan Province, China.
⁶ China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
⁷ Shenyang First People's Hospital, Shenyang Medical College Affiliated Shenyang Brain Hospital, Shenyang 110041, Liaoning Province, China.
⁸ Department of Geriatric Medicine, China National Clinical Key Specialty, Guangzhou First People's Hospital; School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong Province, China.
⁹ Department of Cognitive Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.

Abstract

Background and objectives: To investigate the relationship between homocysteine levels and post-stroke cognitive impairment (PSCI) in Chinese female and male populations with minor acute ischemic stroke or transient ischemic attack.

Materials and methods: A total of 1070 participants with clinically confirmed acute minor ischemic stroke or transient ischemic attack and baseline homocysteine information from a nationwide multicenter prospective registry study in China were included in this study. Of these, 919 patients had cognitive assessments at 3-month follow-ups and 584 participants had cognitive assessments at 12-month follow-ups. The incidence of PSCI was defined as a Montreal Cognitive Assessment score ≤22. The differences in homocysteine levels and the incidence of PSCI were compared between female and male populations. Relationships between homocysteine levels and the incidence of PSCI in female and male populations were analyzed using multiple logistic regression, respectively.

Results: Females had lower baseline homocysteine levels than males. Compared to males, females had lower education levels, lower rates of smoking and alcohol intake, and higher rates of diabetes and hypertension. No relationship was observed between elevated homocysteine level and 3-month PSCI incidence in either females or males. After adjusting the confounders, elevated baseline homocysteine significantly increased the 12-month PSCI risk (odds ratio 3.28, 95% confidence interval 1.47-7.34, P = 0.004) in females, but not in males (odds ratio 0.86, 95% confidence interval 0.49-1.49, P = 0.586).

Conclusion: Elevated homocysteine levels increased the 12-month PSCI risk in females, but not in males with minor acute ischemic stroke or transient ischemic attack.

Keywords: cognitive impairment; female; homocysteine; sex difference; stroke.