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Metabolic Stress May Play Important Role After Stroke

Diabetes, HDL, homocysteine shown to predict post-stroke cognitive function

WEDNESDAY, Nov. 28 (HealthDay News) -- Diabetes, lower high-density lipoprotein (HDL) cholesterol and higher homocysteine are all linked with poorer cognitive function in stroke survivors, indicating that metabolic stress may play a role in determining post-stroke recovery, according to research published in the Nov. 27 issue of Neurology.

George C. Newman, M.D., Ph.D., of the Albert Einstein Medical Center in Philadelphia, and colleagues analyzed data from 3,680 subjects in the Vitamin Intervention for Stroke Prevention trial. This trial enrolled adults who recently had a mild or moderate stroke to see if lowering total plasma homocysteine (tHcy) with vitamins would reduce additional strokes or heart attacks. The primary outcome measures in the current study were scores on the Mini-Mental State Examination (MMSE) and modified Rankin Scale (mRS).

During two years of follow-up, subjects' MMSE and mRS scores slightly improved. Factors associated with poorer cognitive recovery included older age, non-white race, diabetes, lower HDL cholesterol and higher homocysteine. Treatment with high doses of pyridoxine, vitamin B12 and folic acid was not associated with any significant effects.

The findings of the study "continue to indicate that metabolic disturbances associated with diabetes mellitus, HDL, and tHcy, or a related biochemical pathway which elevates plasma tHcy, are significant risk factors for progressive vascular impairment. They also are consistent with a major role for HDL as a potential target for future studies," the authors write.

Three of the study's authors received funding to conduct the original trial that yielded this data.

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