Hyperhomocysteinemia as a Risk Factor for Cerebral Infarction

Lee, Myung Hee

Abstract

BACKGROUND
Homocysteine (Hcy) is known to increase the risk of cerebrovascular disease. I investigated this association in cerebral infarction (CI) and established reference intervals for serum total Hcy concentrations among individuals aged 40 or over in Korea. METHODS: I measured Hcy concentrations in the sera from 93 healthy controls (male 74, female 19) and 742 patients with CI (male 616, female 126) by a fluorescent polarization immuno assay technique using Axsym system (Abbott Laboratories, IL, USA). RESULTS: In CI group, the following parameters were significantly higher (P<0.001) than in normal control (NC): the serum Hcy level (13.4+/-6.6 vs. 10.3+/-2.6 micromol/L), age (67.1+/-9.0 vs. 62.6+/-9.9 years), C-reactive protein (10.2+/-22.2 vs. 5.5+/-6.4 mg/dL), and the prevalence of hypertension (69 vs. 33%) and diabetes mellitus (DM) (38 vs. 5%). The serum folate level in CI group was significantly lower than in NC group (7.5+/-4.1 vs. 8.8+/-5.0 ng/mL, P=0.037). The mean and upper reference limit of Hcy in male control (10.7 and 14.9 mol/L) were significantly higher than in female control (8.1 and 10.8 micromol/L). The risk of CI was higher in subjects with old age (> or =60 years), hypertension, DM, hyperhomocysteinemia, high creatinine, and in the highest Hcy quartile (> or =15.1 micromol/L) compared to the lowest Hcy quartile (<9.6 micromol/L) with the crude odds ratios of 2.1, 4.3, 10.5, 7.4, 3.0, and 6.6, respectively; in multivariate analysis, the risk of CI was independently associated with hypertension, DM, hyperhomocysteinemia and adjusted odds ratios were 3.6, 5.3, and 7.1, respectively. In CI group, Hcy exhibits negative correlations (P<0.001) with folate (r=-0.356) and vitamin B12 (r=-0.256). CONCLUSIONS: Hyperhomocysteinemia may represent an independent risk factor for cerebrovascular disease.