Relationship between elevated homocysteine levels and the degree of white matter lesions in stroke patients

Abstract

This study explores the relationship between elevated homocysteine (Hcy) levels and white matter lesion (WML) severity in stroke patients, aiming to clarify Hcy role in stroke pathology and support clinical treatment and prevention strategies for cerebrovascular diseases. A retrospective analysis was conducted on 200 stroke patients from Guyuan People's Hospital (2022-2024). Hcy levels were measured using a Beckman AU5800 analyzer, and WML severity was assessed via magnetic resonance imaging using the Fazekas scale. Carotid intima-media thickness (cIMT) was measured by ultrasound. The mean Hcy level was significantly higher in the moderate to severe WML group (16.2 ± 5.3 μmol/L) compared to the mild group (11.4 ± 3.8 μmol/L, P < .001), showing a positive correlation with WML severity. The moderate to severe group also had significantly higher left and right cIMT (P < .001). Logistic regression identified age, hypertension, diabetes, Hcy levels, and right-sided cIMT as independent predictors of moderate to severe WML. Receiver operating characteristic curve analysis indicated high diagnostic value for both Hcy levels and right-sided cIMT, with combined use improving assessment accuracy. Elevated Hcy levels and increased right-sided cIMT are independent risk factors for moderate to severe WML in stroke patients. Combining these measures improves assessment accuracy and highlights the need for targeted interventions. Future research should investigate Hcy and cIMT mechanisms and interventions to enhance clinical application.

Keywords: Fazekas scale; MRI; carotid intima-media thickness; homocysteine; stroke; white matter lesions.

Figure 1.

ROC curve diagram for assessing the severity of white matter lesions (WML) using right cIMT and Hcy. cIMT = carotid intima-media thickness, Hcy = homocysteine, ROC = receiver operating characteristic.