5′-methylthioadenosine modifies the association between homocysteine metabolism and ischemic stroke: a nested case–control study

This study aimed to elucidate the interrelationships among 5′-Methylthioadenosine (MTA), Homocysteine (Hcy), and ischemic stroke (IS) and to examine the mediating role of MTA via Hcy metabolism, with the ultimate goal of informing stroke prevention strategies and guiding further research. This study was based on cohorts established through a hypertension health management program and a comprehensive stroke prevention project for high-risk participants at community health centers. Basic demographic information was collected via questionnaires and physical examinations.

A nested case–control study was designed, comprising 148 participants with IS as the case group and 148 non-IS individuals as controls. Plasma concentrations of MTA, Hcy, and other metabolites were measured using liquid chromatography-tandem mass spectrometry (LC–MS/MS). The association between MTA levels and IS was analyzed using a restricted cubic spline (RCS) model.

Furthermore, structural equation modeling (SEM) was performed with AMOS 24.0 to assess the mediating effect of MTA on IS through Hcy. A significant inverse correlation was observed between MTA levels and the risk of IS (p