Homocysteine and the risk of ischemic stroke in a triethnic cohort: The Northern Manhattan study

Ralph L. Sacco, Kishlay Anand, Hye Seung Lee, Bernadette Boden-Albala, Sally Stabler, Robert Allen, Myunghee C. Paik

Research output: Contribution to journalArticlepeer-review


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 ≥15 μmol/L compared with <10 μmol/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 μmol/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 Hey elevations above 15 μmol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 μmol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.

Original languageEnglish (US)
Pages (from-to)2263-2269
Number of pages7
Issue number10
StatePublished - Oct 2004


  • Cerebrovascular disorders
  • Ethnic groups
  • Homocyst(e)ine
  • Risk factors
  • Women

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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