title: Determinants and associations of homocysteine and prothrombotic risk factors in Kuwaiti patients with cerebrovascular accident.
abstract: OBJECTIVE
  The objective of this study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents (CVAs).
  
  
  METHODS
  In this case-control study, plasma total homocysteine (tHcy), lupus anticoagulant, protein C, protein S, activated protein C resistance (APC-R) and antithrombin were measured in 102 patients (60 males and 42 females) and 167 controls (87 males, 80 females). Serum vitamin B(12), folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate (GFR) was calculated.
  
  
  RESULTS
  13 (22%) of the 60 male patients, and 16 (39%) of the 42 female patients had hyperhomocysteinemia. Median (interquartile range) tHcy was higher in male patients [11.22 micromol/l (9.60-15.40)] than female patients [10.05 micromol/l (8.72-17.54)]. On binary logistic regression analysis, the significant (p < 0.05) determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B(12) and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA (OR = 9.55; p = 0.047) in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors (protein C, APC-R and factor VIII) to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy.
authors.affiliation: Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait. segunade@yahoo.com
authors.forename: Olusegun A
authors.initials: OA
authors.lastname: Mojiminiyi
authors.forename: Rajaa
authors.initials: R
authors.lastname: Marouf
authors.forename: Abdel Raoof
authors.initials: AR
authors.lastname: Al Shayeb
authors.forename: Mohammad
authors.initials: M
authors.lastname: Qurtom
authors.forename: Nabila A
authors.initials: NA
authors.lastname: Abdella
authors.forename: Hanan
authors.initials: H
authors.lastname: Al Wazzan
authors.forename: Salah
authors.initials: S
authors.lastname: Al Humood
authors.forename: Majeda Abdul
authors.initials: MA
authors.lastname: Samad
authors.forename: Hadeel
authors.initials: H
authors.lastname: El-Muzaini
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000453:epidemiology; D007730:Kuwait / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D019851:Thrombophilia / Q000097:blood*
chemical_list: D015415:Biomarkers; D006710:Homocysteine