[Correlation between plasma level of homocysteine and cerebral large-artery atherosclerosis].

OBJECTIVE

To identify whether high level of plasma homocysteine is an independent risk factor for potential cerebral large-artery atherosclerotic stenosis determined by digital subtraction angiography (DSA) in patients with ischemic stroke.

METHODS

276 adult patients with ischemic stroke experienced DSA were selected, and 224 patients with potential large-artery atherosclerotic stenosis (grade > 50%, not less than one of vascular) and 52 controls without stenosis or mild grade (grade < or = 50%) were included. Plasma homocysteine level was analyzed and conventional risk factors of cerebral stroke such as sex and age, hypertension, diabetes, long-smoking, long-alcohol and plasma levels of triglyceride, high-density lipoprotein, low-density lipoprotein was evaluated in 276 subjects.

RESULTS

The proportion of subjects with high level of plasma homocysteine (> 15 micromol/L) was significantly higher in patients with potential atherosclerotic stenosis than those without (38.8% versus 15.4%; OR 3.49, 95% CI 1.57 - 7.77, P = 0.001). Based on multivariable stepwise logistic regression model, the odds ratio of homocysteine levels was 4.10 (95% CI 1.80 - 9.32, P = 0.001) with additional adjustment for conventional risk factors. The effect of homocysteine was more pronounced in the presence of hypertension (OR = 4.89), old age (OR = 4.79) and low level of plasma high density lipoprotein (OR = 10.46).

CONCLUSIONS

It is suggested that high level of plasma homocysteine is an independent risk factor for cerebral large-artery atherosclerosis. The effect of homocysteine is more pronounced in the presence of other risk factors of ischemic stroke.