Hyperhomocyst(e)inemia and Risk of Ischemic Stroke Among Young Asian Adults

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Abstract
Background and Purpose — Hyperhomocyst(e)inemia is emerging as a possible risk factor for stroke, possibly because of accelerated atherosclerosis. There are no previous publications evaluating homocyst(e)ine in young Asian ischemic stroke patients. We conducted a case-control study examining homocyst(e)ine, vitamin B 12 , and folate levels in young, first-ever Asian ischemic stroke patients. Methods — We prospectively recruited 109 consecutive young (12 , and folate were assayed. Stroke mechanisms were subtyped using TOAST study criteria. Results — Mean age was 43.8 (cases) and 43.1 (controls) years; 71.6% were male (cases and controls). Diabetes mellitus, hypertension, and hyperlipidemia were significantly more prevalent in cases. Mean fasting homocyst(e)ine levels were significantly higher in cases (13.7 μmol/L, 95% CI: 12.7 to 14.9) than controls (10.8 μmol/L, 95% CI: 9.9 to 11.8, P 12 levels were significantly lower in cases (299.5 pmol/L, 95% CI: 266.7 to 332.3) than controls (394.5 pmol/L, 95% CI: 357.9 to 431.0, P P P =0.001) for every 1 μmol/L increase in log homocyst(e)ine. Conclusions — Hyperhomocyst(e)inemia is an independent risk factor for ischemic strokes in young Asian adults. The relationship between increasing homocyst(e)ine and stroke risk is strong, graded, and significant. The association with large-artery strokes suggests that hyperhomocyst(e)inemia may increase stroke risk via a proatherogenic effect.