Plasma total homocysteine levels and cranial magnetic resonance imaging findings in elderly persons: the Cardiovascular Health Study.
BACKGROUND
An elevated plasma total homocysteine (tHcy) level is associated with an increased risk of vascular disease. Some studies have shown associations between tHcy level and small-vessel disease of the brain on magnetic resonance imaging (MRI).


METHODS
In the Cardiovascular Health Study, 622 elderly participants without a history of transient ischemic attack or stroke had results for tHcy level and cranial MRI. We sought associations between tHcy level and MRI findings of ventricular grade, sulcal grade, white matter grade, and infarcts. We controlled for other factors, including levels of creatinine, folate, and vitamins B(6) and B(12) and methylenetetrahydrofolate reductase genotype.


RESULTS
After controlling for age and sex, tHcy level was not associated with the individual MRI findings. Further adjustments for other factors and other blood tests had little effect on these findings. The only significant finding was a linear trend across quintiles of tHcy level and a pattern of MRI findings combining infarcts and high white matter grade. The linear trend remained significant after controlling for other risk factors and atherosclerotic markers (top quintile vs bottom quintile odds ratio, 3.3; 95% confidence interval, 0.96-11.20; P =.04 for linear trend) but was slightly diminished after further controlling for creatinine, folate, and vitamins B(6) and B(12) (odds ratio, 3.2; 95% confidence interval, 0.81-13.10; P =.07 for linear trend).


CONCLUSIONS
We were unable to confirm the results of previous studies with respect to tHcy level and individual MRI findings, although an association was seen for an MRI pattern combining infarcts and high white matter grade.
Longstreth
W T
WT
Department of Neurology, University of Washington, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2420, USA.
Katz
Ronit
R
Olson
Jean
J
Bernick
Charles
C
Carr
J Jeffrey
JJ
Malinow
M René
MR
Hess
David L
DL
Cushman
Mary
M
Schwartz
Stephen M
SM
D000368:Aged; D000375:Aging / Q000097:blood* / Q000473:pathology; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D011859:Radiography; D012307:Risk Factors
D006710:Homocysteine