Which Ischemic Stroke Subtype Is Associated with Hyperhomocysteinemia?

Abstract

Background: Stroke is still a major global health problem in both developed and developing countries. Defining stroke subtype and underlying etiologies is a major step to choose the best method for prophylaxis. Homocysteine is an endothelial toxin and elevated levels have been associated with stroke risk. In this study, we hypothesized that serum total homocysteine level may be related with specific atherothrombotic ischemic stroke subtypes and aimed to find if high serum homocysteine levels are correlated with any specific ischemic stroke subtype.

Methods: Patients with ischemic stroke and aged between 18 and 65 are included. Ischemic stroke subtype is defined according to Causative Classification System. Hospital records are examined retrospectively to define patient demographics, ischemic stroke subtype, vascular risk factors, serum homocysteine, B12, and folic acid levels.

Results: A total of 262 patients were included. Serum homocysteine level was elevated (≥16 µmol/L) in 99 patients (37.79%). The rate of patients with hyperhomocysteinemia was significantly more common in strokes due to intracranial stenosis (72.41%) (odds ratio 8.138; 95% confidence interval 2.366-27.989; P < .01) than extracranial large artery stenosis (52.00%), craniocervical arterial dissections (35.71%), cardioembolic strokes (27.87%), and lacunar infarctions (25.00%) after adjustment for other risk factors. High homocysteine levels were significantly more common in men and smokers (P < .05).

Conclusions: Elevated levels of serum homocysteine are correlated with ischemic strokes due to intracranial large artery stenosis in young and middle-aged patients. This association may have an implication in stroke prophylaxis for intracranial atherosclerosis by using homocysteine-lowering therapies.

Keywords: Ischemic stroke; homocysteine; intracranial stenosis; subtype.