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

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.

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.

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).

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.