Association Between Metabolic Syndrome and Plasma Homocysteine Level in Patients with Ischemic Stroke

Park, Jong Ho; Shin, Dong Jin; Park, Hyeon Mi; Lee, Yeong Bae; Shin, Won Chul

Abstract

BACKGROUND
Metabolic syndrome (MS) and homocysteine (Hcy) are known to contribute to developing atherosclerothrombosis in ischemic stroke. However, there have been controversies regarding the relationship between insulin resistance and plasma Hcy levels in healthy subjects. Our aim was to determine the possibility of a relationship between MS and elevated Hcy in ischemic stroke patients. METHODS: We investigated demographic features and risk factors in 221 patients from Gachon Stroke Registry between March 2003 and February 2004. The stroke subtypes were categorized as large artery atherosclerosis (LAA), small artery occlusion (SAO) and cardioembolism (CE). MS was defined as the followings; impaired fasting glucose, impaired glucose tolerance or IDDM with two or more among 1) hypertension (antihypertensive treatment and/or BP 160/90 mmHg), 2) dyslipidemia (TG >or=150 mg/dL and/or HDL-C (<35 in men, <39 mg/dL in women)), 3) obesity (BMI >or=25 kg/m2 or waist circumference 90 in men, 80 cm in women). RESULTS: Hcy, total cholesterol, and fibrinogen levels were higher in MS(+) than in MS(-) (p=0.026, 0.021 and 0.025). The Hcy level was higher in LAA patients than in SAO and CE patients (14.1 +/- 6.8, 12.0 +/- 6.2, 11.0 +/- 4.3 mol/L, p=0.009). It was significantly higher in MS(+) than is MS(-) in SAO patients (15.4 +/- 9.5 vs 10.5 +/- 2.9 mol/L, p=0.016), while not observed in LAA or CE patients. Among the MS(+), LAA was more prevalent (48.6%) than SAO (36.1%) and CE (15.3%). CONCLUSIONS: Elevated Hcy level may be associated with ischemic stroke with MS. Further studies remain to be investigated to clarify whether lowering the elevated Hcy can be an another important asset in reducing the risk not only for stroke, but also for MS.