The Association Between Homocysteine And Ischemic Stroke

Objective: In recent years, many epidemiological studies have suggested that elevated homocysteine may be an important and modifiable risk factor for atherosclerotic vascular disease, aterial and venous thrombosis. In the pathogenesis of atherosclerosis , homocysteine may impair endothelia cells, promote vascular smooth muscle cells proliferation and change the coagulation system. Ischemic stroke is the pathologic result of many factors, which work in long time. Hyprtension, diabetes mellitus, hyperlipidemia and smoking have been recognized as conventional risk factors, the association between these factors and homocysteine is conflicting. Ischemic stroke can be classcified into several subtypes, each due to different risk factors. Homocysteine may relate to certain pathophysiological subtypes of ischemic stroke. We examined the association between homocysteine and ischemic stroke, and coventional risk factors, compared the different risk factors of subtype of ischemic stroke, to explore the risk factors of atherosclerotic vascular disease, contribute to treating and preventing of ischemic stroke.Methods: In this study, 105 cases (71 men, 34 women and mean age, 63.32 years) with ischemic stroke defined by the Chinese Fourth Cerebrovascular Disease Meeting Criteria were examined. According to TOAST criteria, they were divided into two subgroups, including large-artery disease and small-artery disease. In addition, 25 normal persons (16 men, 9 women and mean age 62.20 years) were made as control group. Fasting blood samples were drawn from an antecubial vein for measurement of plasma glucose, plasma lipids, plasma total homocysteine. All subjects past history, example as smoking, hypertension, diabetes and hyperlipidemia were also registered. The measurement of tHcy were used by enzyme conversion immunoassay.Results: 1. Although age and ratio of sex were similar in each groups, the cases had signficantly higher ratio of hypertension, diabetes, hyperlipidemia and smoking (PO.01 or P<0.05). The mean plasma homocysteine levels of ischemic stroke (24.85 u mol/L, 95%CI 21.09-29.60) were significantly higer than the control group (16.18 H mol/L, 95%CI 13.30-19.06, PO.05). In cases group, homocysteine levels were higher in men than hi women (P<0.05) and there was no difference in control group. Compared with the lowest quartile, the uppest quartile of homocysteine was associated with an OR of ischemic stroke of 3.59 (95%CI, 1.15-11.16). There were 6 cases, which had no conventional risk factors, their mean homocysteine was significantlyhigher than the control group.2. There was a significant difference of homocysteine between large-artery disease and small-artery disease, or the control group, but there was no significant difference between small-artery disease and the control group. Compared with the lowest quartile, the upper quartile of homocysteine was associated with an OR of ischemic stroke of 1.07 (95%CI, 1.02-1.13) due to large-artery disease, for the third quartile of 2.56 (95%CI, 1.23-5.37),and for the fourth quartile of 4.80 (95%CI, 1.41-16.55).3. There was no association between plasma homocysteine and hypertension, hyperlipidemia, diabetes or smoking. According to whether had hypertension, hyperlipidemia, diabetes, smoking or not, all subjects were separately divided into two types, the results suggested that there were no significant difference.4. There was no significant difference between laege-artery disease and small-artery disease as for conventional risk factors, but large-artery disease had significant higher homocysteine than the small-artery disease.5. By logistic regression analysis, the final model consists of hypertension (OR=5.390), hypercholesterolemia (OR=5.442), diabetes (OR=5.466), and tHcy (OR=1.160), which had significant relation with ischemic stroke. However, hypertension, smoking and tHcy had significant relation with large-artery disease.Conclusion: Levels of homocysteine we...