Serum Total Homocysteine Concentrations and Risk of Stroke and Its Subtypes in Japanese

Abstract

Background-To date, no prospective studies have examined the association between serum homocysteine levels and the risk of stroke and stroke subtypes in Asian populations. Methods and Results-A prospective, nested, case-control study of Japanese subjects 40 to 85 years of age was conducted by using frozen serum samples from 11 846 participants in cardiovascular risk surveys collected from 1984 to 1995 for one community and 1989 to 1995 for the other two communities. By the end of 2000, we identified 150 incident strokes, the subtypes of which were confirmed by imaging studies. Three control subjects per case were selected by matching for sex, age, community, year of serum storage, and fasting status. Serum total homocysteine levels were measured by high-performance liquid chromatography. Compared with control subjects, total (nϭ150), hemorrhagic (nϭ52), and ischemic (nϭ98) strokes had higher geometric mean values of total homocysteine and higher proportions of homocysteine Ն11.0 mol/L. The multivariate odds ratios (95% CI) for highest (Ն11.0 mol/L) versus lowest quartiles (Ͻ7.0 mol/L) of homocysteine after adjustment for body mass index, smoking, alcohol intake, hypertension, serum total cholesterol, and other cardiovascular risk factors were 2.99 (1.51 to 5.93) for total stroke, 3.89 (1.60 to 9.46) for ischemic stroke, 3.36 (1.27 to 8.90) for lacunar infarction, and 1.63 (0.44 to 6.00) for hemorrhagic stroke. The respective multivariate odds ratios associated with a 5-mol/L increase in homocysteine were 1.40 (1.09 to 1.80), 1.52 (1.07 to 2.14), 1.48 (1.01 to 2.18), and 1.10 (0.76 to 1.59). The excess risk of total and ischemic strokes did not vary significantly according to sex, age, smoking status, or hypertensive status. Conclusions-High total homocysteine concentrations were associated with the increased risk of total stroke, more specifically ischemic stroke and lacunar infarction, among Japanese men and women.

Homocysteine (Hcy) Follow-Up Study

“…The multivariate odds ratios of Hcy (after adjustment for body mass index, smoking, alcohol intake, hypertension, serum cholesterol, and other cardiovascular risk factors) were 2.99 for total stroke, 3.89 for ischemic stroke, 3.36 for lacunar infarction, and 1.63 for hemorrhagic stroke. 17 In our study no such effect was found -no correlation was observed between Hcy concentration and the development of CVA later on. Another prospective follow-up cohort study examined serum Hcy in relation to mortality and morbidity from coronary heart disease in 1,368 women.…”

Serial changes in plasma homocysteine in acute clinical stroke

“…There is conflicting evidence about the relationship of homocysteine and hemorrhagic stroke with some studies finding raised homocysteine levels in hemorrhagic stroke [23,24], others reporting the same in ischemic stroke [25], and still others finding raised homocysteine in both stroke subtypes [26]. Our finding of raised homocysteine concentrations in hemorrhagic stroke cases adds to the homocysteine-hemorrhagic stroke linkage.…”

The Study of Biomarker Homocysteine as Risk Factor in Acute Cerebral Stroke Patients of Western Rajasthan

“…[8][9][10] There is evidence from laboratory and clinical studies that elevated Homocysteine (eHcy), exerts direct toxic effects on both the vascular and nervous systems.…”