A study of clinical profile and risk factors in Ischemic stroke with special reference to serum homocysteine and lipid profile: a cross sectional observation study
DOI:
https://doi.org/10.18203/2349-3933.ijam20162868Keywords:
Homocysteine, Ischemic stroke, Risk factorAbstract
Background: Ischemic stroke (IS) is one of the major reasons of disability and death throughout the world. Every year, around 4.4 million people die because of IS all around the world. The objective was to study clinical profile and risk factors in patients with IS and to find out the association of ischemic stroke with serum lipid and serum homocysteine level.
Methods: A cross sectional observation study was performed on 64 IS patients after dividing in to group 1 (n=10, age <40 years) and group 2 (n = 54, age >40 years) from December 2008 to November 2010. A detailed history, risk factors along with quantitative estimation of serum homocysteine, total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein was performed.
Results: The most common premonitory symptoms were headache (70% versus 31.48%), giddiness/vertigo (10% versus 24.07%) and tingling/numbness (40% versus 16.66%) in group 1 and group 2 respectively. Most of the patients were having stage 1 hypertension in Group 1 (50%) whereas in group 2 (53.65%) most of the patients were stage 2 hypertensive. The most common risk factors for IS were hypertensive (60% versus 90.65%) followed by diabetes mellitus (0% versus 62.9%) and transient ischemic attack (0% versus 42.55%) in group 1 and group 2 respectively. Most of the patients in were having moderate hyperhomocysteinemia in Group 1 (40%) and group 2 (24.05%) and only 10% and 11.10% of the patients were having mild hyperhomocysteinemia. In group 1 and Group 2, raised cholesterol, raised triglyceride, raised LDL and low HDL was recorded in 30% versus 42.55%, 30% versus 31.48%, 40% versus 68.45% and 60% versus 27.75% of patients respectively.
Conclusions: High level of homocysteine and abnormal lipid profile mainly increased LDL and decreased HDL -C level is associated with increased risk of ischemic stroke.
References
Murray DJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet. 2012;349(9061):1269-76.
Banerjee AK. Pathology of cerebrovascular disease.Neurology India. 2000;48(4):305-7.
Singh RB, Suh IL, Singh VP. Hypertension and stroke in Asia, prevalence, control and strategies in developing countries for prevention. J Human Hyper. 2010;14(10):749-63.
Fang XH, Kronmal RA, Li SC, Longstreth WT, Cheng XM, Wang WZ, et al. Prevention of stroke in urban China a community-based intervention trial. Stroke. 1999;30(3):495-501.
Danesi MA, Oneyola YA, Onitiri AC. Risk factors associated with cerebrovascular disease in Nigerians (a case-control study). E Afr Med J. 1983;60(3):190-5.
Modi M, Prabhakar S, Majumdar S, Khullar M, Lal V, Das CP. Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario. Neurology India. 2005;53(3):297-302.
Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991;325(6):373-81.
Yaari S, Goldbourt, Even ZS, Neufeld HN. Associations of serum high density lipoprotein and total cholesterol with total, cardiovascular, and cancer mortality in a 7-year prospective study of 10 000 men. Lancet. 1981;1(8228):1011-5.
Tranmer BI, Commichau CSL, Popp AJ. Ischemic cerebrovascular disease. In Popp AJ, Deshaies EM editor; Guide to the Primary Care of Neurological Disorders. 2nd edition, Thieme Medical Publishers, New York, 2007:288.
Bhaskar MV, Vennela D, Preethi AS. Study of homocysteine, lipoprotein (a) and lipid profile in ischemic stroke. Sch J App Med Sci. 2014;2(4):1247-50.
Schaller B, Graf R. Cerebral venous infarct ion: the pathophysiological concept. Cerebrovasc Dis. 2004;18(3):179-88.
Fischer M, Schaebitz W. An overview of acute stroke, therapy past, present and future. Arch Intern Med. 2006;160:3196-206.
Terwecoren A, Steen E, Benoit D, Boon P, Hemelsoet D. Ischemic stroke and hyperhomocyscysteinemia: truth or myth? Acta Neurol Belg. 2009;109(3):181-8.
Narang APS, Verma I, Kaur S, Narang A, Gupta S, Avasthi G. Homocysteine - risk factor for ischemic stroke? Indian J Physiol Pharmacol. 2009;53(1):34-53.
Sharabi Y, Doolmsn T, Rosenthal T. Homocysteine levels in hypertensive patients with a history of cardiac or cerebral atherothrombotic events. Amer J Hyperten. 1999;12:766-71.
Willey JZ, Xu Q, Boden AB, Paik MC, Moon YP, Sacco RL et al. Lipid profile components and risk of ischemic stroke. Arch Neurol. 2009;66(11):1400-6.
Tan KS, Navarro JC, Wong KS, Huang YN, Chiu HC, Poungvarin N et al. Clinical profile, risk factors and aetiology of young ischaemic stroke patients in Asia: a prospective, multicentre, observational, hospital-based study in eight cities. Neurology Asia. 2014;19(2):117-27.
