Hyperhomocysteinemia independently associated with adult moyamoya disease: hospital based study of 237 patients

AIM The etiology and pathogenesis of Moyamoya Disease (MMD) remains obscure. The present study aims to clarify the risk factors for adult MMD in patients from South China. MATERIAL AND METHODS We prospectively studied adult patients who were angiographically diagnosed with MMD, compared the demographic profiles, medical history and clinical characteristics between adult MMD and non-MMD stroke patients. Logistic regression analysis was used to determine the risk factors associated with adult MMD. RESULTS A total of 35 adult MMD patients and 202 adults patients with non-MMD stroke were included. Percentages of patients with bilateral MMD who underwent bypass surgery in the two groups were 48.6% and 28.6%, respectively, and both were significantly lower than those reported in patients from Korea and the US (P 0.05). After adjusting for baseline demographics and potential confounders, multivariate logistic regression analysis was done and showed that the plasma homocysteine level (OR: 1.10; 95% CI: 1.06-1.14) and technological worker (OR: 4.23; 95% CI: 1.65-10.89) were independently associated with adult MMD. CONCLUSION Hyperhomocysteinemia and the type of occupation were found to be the independent risk factors of adult MMD in patients from South China. However, there is still necessity to perform further research to clarify the pathogenesis of MMD. Given the lack of understanding about the risk factors and prevention measures of MMD, we suggest bypass surgery to be used in treatment of MMD in clinical practice in China to achieve more desirable effects in the management of the disease.