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January 02, 2019Article

Serum homocysteine level is related to cerebral small vessel disease in a healthy population

Ki-Woong Nam, Hyung-Min Kwon, Han-Yeong Jeong, Jin-Ho Park, Hyuktae Kwon, Su-Min Jeong
First published January 2, 2019, DOI: https://doi.org/10.1212/WNL.0000000000006816
Ki-Woong Nam
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Hyung-Min Kwon
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Han-Yeong Jeong
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Jin-Ho Park
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Hyuktae Kwon
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Su-Min Jeong
From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea.
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Citation
Serum homocysteine level is related to cerebral small vessel disease in a healthy population
Ki-Woong Nam, Hyung-Min Kwon, Han-Yeong Jeong, Jin-Ho Park, Hyuktae Kwon, Su-Min Jeong
Neurology Jan 2019, 10.1212/WNL.0000000000006816; DOI: 10.1212/WNL.0000000000006816

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Abstract

Objective To evaluate the relationship between serum total homocysteine (tHcy) levels and cerebral small vessel disease (cSVD) in a healthy population.

Methods We included consecutive participants who visited our department for health checkups between 2006 and 2013. We rated white matter hyperintensity volumes using both the Fazekas score and semiautomated quantitative methods. We also evaluated lacunes, cerebral microbleeds, and enlarged perivascular spaces (EPVS), which are involved in cSVD. To assess the dose-dependent relationship between tHcy and cSVD parameters, we scored the burdens of each radiologic marker of cSVD.

Results A total of 1,578 participants were included (age 55 ± 8 years, male sex 57%). In the multivariable analysis, tHcy remained an independent predictor of the white matter hyperintensity volume (B = 0.209; 95% confidence interval [CI] = 0.033–0.385, p = 0.020), presence of cerebral microbleeds (adjusted odds ratio = 2.800; 95% CI = 1.104–7.105, p = 0.030), and moderate to severe EPVS (adjusted odds ratio = 5.906; 95% CI = 3.523–9.901, p < 0.001) after adjusting for confounders. Furthermore, tHcy had positive associations with periventricular Fazekas score (p = 0.001, p for trend <0.001), subcortical Fazekas score (p = 0.003, p for trend = 0.005), and moderate to severe EPVS lesion burden (p < 0.001, p for trend <0.001) in a dose-dependent manner.

Conclusions Serum tHcy level is correlated with cSVD development in a dose-dependent manner. These findings provide us with clues for further studies of the pathophysiology of cSVD.

  • Received May 28, 2018.
  • Accepted in final form September 27, 2018.
  • © 2019 American Academy of Neurology

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