Homocysteine and the Risk of Ischemic Stroke in a Triethnic Cohort

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Abstract
Background and Purpose— The level of total homocysteine (tHcy) that confers a risk of ischemic stroke is unsettled, and no prospective cohort studies have included sufficient elderly minority subjects. We investigated the association between mild to moderate fasting tHcy level and the incidence of ischemic stroke, myocardial infarction, and vascular death in a multiethnic prospective study. Methods— A population-based cohort was followed for vascular events (stroke, myocardial infarction, and vascular death). Baseline values of tHcy and methylmalonic acid were measured among 2939 subjects (mean age, 69±10; 61% women, 53% Hispanics, 24% blacks, and 20% whites). Cox proportional models were used to calculate hazard ratios (HRs) and 95% CIs in tHcy categories after adjusting for age, race, education, renal insufficiency, B 12 deficiency, and other risk factors. Results— The adjusted HR for a tHcy level ≥15 μmol/L compared with Conclusions— Total Hcy elevations above 15 μmol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 μmol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.