Associations between serum Homocysteine, vitamin B9, and vitamin B12 levels and the formation of intracranial Aneurysms: A systematic review and meta-analysis

Abstract

Cardiovascular diseases, including cerebrovascular diseases, represent a major global public health challenge, contributing significantly to morbidity and mortality rates worldwide. Intracranial aneurysms (IAs) are a concerning manifestation due to the risk of rupture and subsequent subarachnoid hemorrhage, which carries a high risk of mortality and long-term disability. Hyperhomocysteinemia, a condition often associated with low levels of vitamins B9 (folic acid or folate) and B12 (cobalamin), has been investigated as a potential risk factor for the formation and rupture of IAs. The present study aimed to conduct a systematic review and meta-analysis to analyze the relationships between serum levels of vitamins B9 and B12, homocysteine, and the formation of IAs. The search included the PubMed/MEDLINE, Scielo, EMBASE, LILACS, and Web of Science databases, and the ROBINS-E tool was used to assess the risk of bias. Four studies, encompassing a total of 11,377 participants, met the inclusion criteria and were included in the final analysis. The meta-analysis revealed a positive association between elevated homocysteine levels and the formation of IAs. Only one study evaluated the relationship with vitamins B9 and B12, suggesting a potential protective effect, but further research is warranted to confirm this association. Our findings reinforce the potential link between hyperhomocysteinemia and the development of IAs. A deeper understanding of the risk factors and underlying mechanisms involved in aneurysm formation is crucial for the development of effective preventive and therapeutic strategies, ultimately aiming to reduce the incidence associated with this condition.