TY - JOUR
T1 - Homocysteine and the risk of ischemic stroke in a triethnic cohort
T2 - 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.
PY - 2004/10
Y1 - 2004/10
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 ≥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.
AB - 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.
KW - Cerebrovascular disorders
KW - Ethnic groups
KW - Homocyst(e)ine
KW - Risk factors
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=4744346011&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=4744346011&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000142374.33919.92
DO - 10.1161/01.STR.0000142374.33919.92
M3 - Article
C2 - 15345803
AN - SCOPUS:4744346011
SN - 0039-2499
VL - 35
SP - 2263
EP - 2269
JO - Stroke
JF - Stroke
IS - 10
ER -