Association of plasma homocysteine concentration with atherosclerotic carotid plaques and lacunar infarction.
OBJECTIVE
Higher plasma total homocysteine (tHcy) levels have been associated with carotid atherosclerosis and cerebral infarction in whites. However, data regarding such associations are limited for Asians. This study examined associations between tHcy levels and severity of carotid atherosclerosis in Japanese subjects. Additionally, because lacunar infarction is the most prevalent type of ischemic stroke in Japan, we also investigated its associations with tHcy levels.


METHODS
The subjects were 152 Japanese patients (age, 66.2+/-11.0 years) at our hospital. Using ultrasound, we evaluated severity of carotid atherosclerosis by plaque score, which is defined by the sum of all plaque (intima-media thickness > or =1.1 mm) height in bilateral carotid arteries. In 112 of 152 patients, the existence of lacunar infarction was evaluated on brain MRI scans.


RESULTS
A moderate linear association was found between tHcy levels and plaque score (r=0.48, P<0.0001). Moreover, tHcy level was associated with plaque score (beta=0.26, P<0.001) independently of traditional atherosclerotic risk factors. In logistic regression analyses, each 1-micromol/L-higher tHcy level was associated with a 1.37-fold-higher [95% confidence interval (CI), 1.19 to 1.58] likelihood for lacunar infarction, increasing the likelihood by 1.22-fold (95% CI, 1.04 to 1.43) independently of traditional atherosclerotic risk factors.


CONCLUSIONS
Higher tHcy levels appear to have associations with increased severity of carotid atherosclerotic plaques and prevalent lacunar infarction in the Japanese. Larger prospective studies are necessary to establish whether higher tHcy levels serve as a harbinger for insidious carotid and cerebrovascular diseases.
Sasaki
Tsutomu
T
Department of Internal Medicine and Therapeutics, Osaka University, Graduate School of Medicine, Osaka, Japan.
Watanabe
Manabu
M
Nagai
Yoji
Y
Hoshi
Taku
T
Takasawa
Masashi
M
Nukata
Masaru
M
Taguchi
Akihiko
A
Kitagawa
Kazuo
K
Kinoshita
Naokazu
N
Matsumoto
Masayasu
M
D000368:Aged; D044466:Asian People; D020520:Brain Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D003710:Demography; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D014463:Ultrasonography
D006710:Homocysteine