Elevated Urinary Methylmalonic Acid/creatinine ratio and Serum Sterol levels in Patients with Acute Ischemic Stroke

Introduction: Sitosterolemia, defined as phytosterolemia, is a rare autosomal recessive disease characterized by elevated blood sterol levels. Our aim was to investigate serum plant sterols, methylmalonic acid, vitamin B12, oxidized-LDL and homocysteine levels in ischemic and hemorrhagic stroke patients and healthy subjects. Material and Methods: 50 healthy subjects (without a family history of coronary artery disease) and 89 patients hospitalized in the Selcuk University neurology clinic or intensive care unit with a diagnosis of stroke were included in this study. Serum plant sterols, homocysteine and methylmalonic acid, oxidized-LDL, total cholesterol, triglycerides, HDL-Cholesterol and vitamin B12 levels were analyzed by gas chromatography-mass spectrometry, liquid-chromatography tandem mass spectrometry, commercially available ELISA kit, spectrophotometry and chemiluminescence methods, respectively. Results: Urinary methylmalonic acid/creatinine ratio (p< 0.05), serum beta-sitosterol levels and beta-sitosterol/cholesterol ratio were significantly higher (p < 0.01) in patients compared to the control group. There was a significant positive correlation between the serum OxLDL-methylmalonic acid, serum homocysteine-urinary methylmalonic acid/creatinine ratio, serum methylmalonic acid-Urinary methylmalonic acid (p< 0.05), serum homocysteine-urinary methylmalonic acid, urinary methylmalonic acid-methylmalonic acid/creatinine ratio, serum methylmalonic acid-methylmalonic acid/creatinine ratio, serum beta-sitosterol-beta-sitosterol/cholesterol, total cholesterol-HDL, total cholesterol-LDL (p < 0.01) levels and negative correlation between vitamin B12-serum methylmalonic acid (p< 0.05), cholesterol-stigmasterol/cholesterol, LDL-stigmasterol/cholesterol (p < 0.01) levels in the patient group. Conclusion: Our findings presented that the serum sitosterol levels were significantly higher in stroke patients compared to controls.