Elevated plasma homocyst(e)ine concentration as a possible independent risk factor for stroke

Homocyst(e)ine refers to the sulfur-containing amino acids homocysteine, homocystine, and homocysteine-cysteine mixed disulfide, which normally exist in plasma in both the free and protein-bound forms. Marked hyperhomocyst(e)inemia is associated with well-recognized complications of occlusive thrombotic events and a characteristic syndrome. It is less clear whether mild to moderate elevations in plasma homocyst(e)ine concentrations (i.e., 1.5-5-fold increases) also represent a risk factor for stroke and, if so, whether it is independent of other recognized risk factors. To examine these questions we compared the plasma homocyst(e)ine levels in 41 patients with acute strokes, 27 patients with transient ischemic attacks, 31 patients with recognized risk factors for but no recent symptoms of cerebrovascular disease, and 31 normal volunteers (controls). Plasma homocyst(e)ine concentration was moderately but significantly higher in the patients than in the controls (p less than 0.0001). Approximately 30% of the patients had homocyst(e)ine levels higher than the controls. No relation was found between homocyst(e)ine concentration and other recognized stroke risk factors or stroke type; however, a positive correlation was found between serum uric acid and plasma homocyst(e)ine levels. These data suggest that a moderately elevated plasma homocyst(e)ine concentration may be an independent risk factor for cerebrovascular disease.