title: Modelling of increased homocysteine in ischaemic stroke: post-hoc cross-sectional matched case-control analysis in young patients.
abstract: OBJECTIVE
  Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS). However, especially in young adults, there is possibility of significantly increased IS risk due to increased normal homocysteinaemia, i.e., hidden (pathologically dormant) prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY) in gender- and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls.
  
  
  METHODS
  We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques.
  
  
  RESULTS
  IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL). At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72% model accuracy, p model=0.001). An increase of THCY with 1.0 micromol/L was associated with 22% higher risk of ischaemic stroke [adjusted OR=1.22 (95%CI 1.03?1.44)]. In this way, novel lower cut-off value for HCY of 11.58 micromol/L in younger patients has been revealed (ROC AUC= 0.67, 95CI% 0.55-0.78, p=0.009).
  
  
  CONCLUSIONS
  The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63%, specificity>68%) irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.
authors.affiliation: Department of Neurology, Medical University 15A, V Aprilov Boulevard, Plovdiv 4000, Bulgaria. pp_atanassova@yahoo.com
authors.forename: Penka A
authors.initials: PA
authors.lastname: Atanassova
authors.forename: Evgeniya
authors.initials: E
authors.lastname: Angelova
authors.forename: Plamen
authors.initials: P
authors.lastname: Tzvetanov
authors.forename: Maria
authors.initials: M
authors.lastname: Semerdjieva
authors.forename: Borislav D
authors.initials: BD
authors.lastname: Dimitrov
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012016:Reference Values; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D006710:Homocysteine