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Homocysteine and the risk of ischemic stroke in a triethnic cohort: the NOrthern MAnhattan Study.
Stroke. 2004 Oct; 35(10):2263-9.S

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, B12 deficiency, and other risk factors.

RESULTS

The adjusted HR for a tHcy level > or =15 micromol/L compared with <10 micromol/L was greatest for vascular death (HR=6.04; 95% CI, 3.44 to 10.60), followed by combined vascular events (HR=2.27; 95% CI, 1.51 to 3.43), ischemic stroke (HR=2.01; 95% CI, 1.00 to 4.05), and nonvascular death (HR=2.02; 95% CI, 1.31 to 3.14). Mild to moderate elevations of tHcy of 10 to 15 micromol/L were not significantly predictive of ischemic stroke, but increased the risk of vascular death (2.27; 95% CI, 1.44 to 3.60) and combined vascular events (1.42; 95% CI, 1.06 to 1.88). The effect of tHcy was stronger among whites and Hispanics, but not a significant risk factor for blacks.

CONCLUSIONS

Total Hcy elevations above 15 micromol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 micromol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.

Authors+Show Affiliations

Department of Neurology, Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY, USA. rls1@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15345803

Citation

Sacco, Ralph L., et al. "Homocysteine and the Risk of Ischemic Stroke in a Triethnic Cohort: the NOrthern MAnhattan Study." Stroke, vol. 35, no. 10, 2004, pp. 2263-9.
Sacco RL, Anand K, Lee HS, et al. Homocysteine and the risk of ischemic stroke in a triethnic cohort: the NOrthern MAnhattan Study. Stroke. 2004;35(10):2263-9.
Sacco, R. L., Anand, K., Lee, H. S., Boden-Albala, B., Stabler, S., Allen, R., & Paik, M. C. (2004). Homocysteine and the risk of ischemic stroke in a triethnic cohort: the NOrthern MAnhattan Study. Stroke, 35(10), 2263-9.
Sacco RL, et al. Homocysteine and the Risk of Ischemic Stroke in a Triethnic Cohort: the NOrthern MAnhattan Study. Stroke. 2004;35(10):2263-9. PubMed PMID: 15345803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine and the risk of ischemic stroke in a triethnic cohort: the NOrthern MAnhattan Study. AU - Sacco,Ralph L, AU - Anand,Kishlay, AU - Lee,Hye-Seung, AU - Boden-Albala,Bernadette, AU - Stabler,Sally, AU - Allen,Robert, AU - Paik,Myunghee C, Y1 - 2004/09/02/ PY - 2004/9/4/pubmed PY - 2005/3/23/medline PY - 2004/9/4/entrez SP - 2263 EP - 9 JF - Stroke JO - Stroke VL - 35 IS - 10 N2 - 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, B12 deficiency, and other risk factors. RESULTS: The adjusted HR for a tHcy level > or =15 micromol/L compared with <10 micromol/L was greatest for vascular death (HR=6.04; 95% CI, 3.44 to 10.60), followed by combined vascular events (HR=2.27; 95% CI, 1.51 to 3.43), ischemic stroke (HR=2.01; 95% CI, 1.00 to 4.05), and nonvascular death (HR=2.02; 95% CI, 1.31 to 3.14). Mild to moderate elevations of tHcy of 10 to 15 micromol/L were not significantly predictive of ischemic stroke, but increased the risk of vascular death (2.27; 95% CI, 1.44 to 3.60) and combined vascular events (1.42; 95% CI, 1.06 to 1.88). The effect of tHcy was stronger among whites and Hispanics, but not a significant risk factor for blacks. CONCLUSIONS: Total Hcy elevations above 15 micromol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 micromol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/15345803/Homocysteine_and_the_risk_of_ischemic_stroke_in_a_triethnic_cohort:_the_NOrthern_MAnhattan_Study_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.STR.0000142374.33919.92?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -