Optimization of prevention of recurrent ischemic stroke by taking into account genetic risk factors

A.O. Volosovets

Abstract


Background. An important task regarding the prevention of ischemic stroke can be realized by improving the provision of medical care to patients and the implementation of measures aimed at preventing the onset of the disease. A separate issue of prevention of recurrent thrombosis of cerebral vessels is the drug prophylaxis of hyperhomocysteinemia, which leads to a number of physiological pathologies, among which one can indicate atherosclerosis, atherothrombosis and venous thrombosis. Purpose: development of a more perfect and effective method for medical prevention of recurrent cerebral ischemic stroke using genetic criteria. Materials and methods. We have examined 150 patients who had an ische­mic stroke (86 men, 64 women), aged 45–84 years (mean age 65.2 ± 9.7 years) at the premises of neurosurgery department N 2 of the Kyiv Clinical Emergency Hospital. All patients were genetically tested in the form of venous blood collection and detection of the mutation pattern of the gene MTHFR C677T (CC, CT or TT variants). Results. The patients were divided into groups according to detected MTHFR C677T gene mutations and prophylactic treatment. Patients with a MTHFR C677T type mutation were included in the CC1 (n = 45) group, which in addition to the main prophylactic treatment received folic acid (vitamin B9) in a dose of 1 mg (optimized prevention). The CC2 group (n = 45) had the same mutation, but received only the main prophylactic treatment (enalapril 20 mg 2 times a day, aspirin 100 mg once daily and rosuvastatin 20 mg once daily). Similarly, patients were included in groups CT1 (n = 21), CT2 (n = 21), TT1 (n = 9) and TT2 (n = 9). The risk of stroke among patients with CC and CT mutations did not significantly differ (p > 0.1) in case of optimized pharmacological prevention. However, in TT mutation, the data has shown a high probability of recurrent stroke due to genetically determined hyperhomocysteinemia and a significant difference in the incidence of repeated cerebral events on the background of treatment with folic acid (0 and 33.3 %, respectively). Conclusions. Thus, an optimized met­hod of pharmacological prevention of acute ischemic stroke allows to effectively prevent recurrent ischemic stroke, depen­ding on the genetic features of the patient.

Keywords


ischemic stroke; prevention; genetic testing

References


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DOI: https://doi.org/10.22141/2224-0586.8.87.2017.121335

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