Hyperhomocysteinemia as a Risk Factor for Intracranial Aneurysms: A Case-Control Study

Objective Homocysteine, an amino acid derived from methionine metabolism, has gained great importance as an important risk factor for cardiovascular diseases as the result of its thrombogenic properties and endothelial injury association. However, its role in the etiology and screening of intracranial aneurysms (IAs) has not been well studied. We aimed to test the hypothesis of a positive association between hyperhomocysteinemia (HHcy) and IAs. Methods A case–control study was performed at a vascular neurosurgery unit in Brazil between 2016 and 2017. In total, 180 patients were included: 142 patients with previous IAs (case group) and 38 patients with a previous diagnosis of arteriovenous malformation and no aneurysms on imaging evaluation (control group). HHcy was defined as homocysteine levels greater than 15 μmol/L. Multivariate models were designed to adjust for potential confounders: age, sex, hypertension, dyslipidemia, and smoker status. Results The case group was older (56.3 ± 12.6 years vs. 40.9 ± 14.0 years, P P  = 0.012), as well as hypertension (45.1% vs. 2.6%, P P  = 0.001), and smokers (41.5% vs. 0.0%, P P  = 0.450). There was a trend toward greater HHcy prevalence in the case group (20.4% vs. 7.9%, P  = 0.073). HHcy was associated with greater age, male sex, hypertension, and smoking status. After multivariate adjustment, HHcy had no association with IAs (odds ratio 1.34, 95% confidence interval 0.30–5.97, P  = 0.703). Conclusions No association was found between HHcy and IAs.