title: Assessment of pre- and post-methionine load homocysteine for prediction of recurrent stroke and coronary artery disease in the Vitamin Intervention for Stroke Prevention Trial.
abstract: Methionine (Met) loading increases total plasma homocysteine (tHcy) and assesses homocysteine metabolism. We tested the hypothesis that pre- or post-Met tHcy will predict recurrent stroke or coronary artery disease (CAD) in a subgroup analysis of the Vitamin Intervention for Stroke Prevention (VISP) trial. VISP subjects with non-disabling stroke underwent measurement of tHcy at baseline (fasting pre- and post-Met load) and were randomized to high/low-dose B-vitamin therapy for prevention of recurrent stroke or CAD. In the sample cohort of 2124 subjects, mean+/-S.D. tHcy levels in micromol/l were pre-Met 13.2+/-4.3, post-Met 30.4+/-9.76, and pre/post-Met Delta 17.1+/-8.3. The hazard ratio (HR) for recurrent stroke was 1.16 (p=0.026) for 1 S.D. higher pre-Met tHcy and 1.15 (p=0.054) for 1 S.D. higher post-Met tHcy. For CAD, the HR for 1 S.D. higher pre-Met tHcy was 1.27 (p=0.001) and was 1.00 (p=0.99) for post-Met tHcy. In survival analyses using pre- or post-Met as covariates, the coefficient of pre/post-Met Delta was not significant for stroke and was only marginally significant for CAD (p<0.08), but was negative. We conclude that fasting, pre-Met tHcy is as effective as post-Met tHcy or pre/post-Met Delta in predicting the risk for stroke and CAD.
authors.affiliation: Department of Neurology, Stroke Program, Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40536-0230, United States. cpetti@uky.edu
authors.forename: Luther C
authors.initials: LC
authors.lastname: Pettigrew
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: James F
authors.initials: JF
authors.lastname: Toole
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D008297:Male; D008715:Methionine / Q000494:pharmacology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000517:prevention & control; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D006710:Homocysteine; D008715:Methionine