Abstract
Background
Although the original homocysteine hypothesis for atherothrombotic disease is falling
out of favor, prior studies did not comprehensively adjust for confounders or explore
specific subgroups of patients who may benefit from serum homocysteine-lowering. We
aimed to determine (1) if elevated total homocysteine (tHcy) affects odds of prevalent
stroke after adjusting for a broad array of pertinent covariates and (2) whether particular
vascular risk factors amplify the effect of high homocysteine on prevalent stroke.
Methods
The independent and interactive effects of elevated tHcy (≥10 μmol/L) on likelihood of prevalent stroke was assessed in the National Health and
Nutrition Examination Survey, a nationally representative cross-sectional sample of
the US population conducted from 1999 to 2004 (n=12,683).
Results
After adjusting for 17 covariates, those with elevated tHcy were more likely to have
prevalent stroke vs. those without elevated tHcy (OR 1.52, 95% CI 1.01–2.29; p=0.045). Individuals with a combination of elevated tHcy and hypertension were substantially
more likely to have prevalent stroke compared to individuals without either condition
(OR 12.02, 95% CI 6.36–22.73 for men and OR 17.34, 95% CI 10.49–28.64 for women).
The association of tHcy with prevalent stroke was strongest in younger individuals
and declined linearly with increasing age.
Conclusions
Elevated tHcy independently increases odds of prevalent stroke. Younger individuals
and those with concomitant hypertension may particularly benefit from tHcy-lowering.
Keywords
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Article info
Publication history
Published online: September 01, 2010
Accepted:
July 19,
2010
Received in revised form:
July 19,
2010
Received:
March 26,
2010
Footnotes
☆Dr. Towfighi presented these findings at a platform presentation at the 7th International Conference on Homocysteine Metabolism in Prague, Czech Republic in June 2009.
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
