title: Relationship of homocysteine with other risk factors and outcome of ischemic stroke.
abstract: OBJECTIVE
  Hyperhomocysteinemia (HH) is an emerging risk factor for ischemic stroke but its role in outcome is controversial. We compare the risk factors, nature of stroke and outcome of patients with and without hyperhomocysteinemia.
  
  
  METHODS
  CT proven ischemic stroke patients were included. The conventional risk factors such as diabetes, hypertension, hyperlipidemia, obesity, smoking, and family history of stroke were recorded. Dietary history was noted. Fasting serum homocysteine (Hcy), B12 and folic acid were estimated after 1 month of stroke. Severity of stroke was assessed by Canadian Neurological Scale (CNS) and outcome at 3 months by Barthel Index (BI) score into good (BI > or = 12) and poor (BI < 12). Serum Hcy, B12 and folic acid were also estimated in 200 normal healthy volunteers.
  
  
  RESULTS
  There were 198 patients with ischemic stroke whose median age was 56 years and 36 were females. In the study group, 41.4% patients were vegetarian, 55.1% hypertensive, 24.7% diabetic, 30.8% smoker, 61.1% sedentary and 28.8% obese. 23.2% had past history of stroke and 21.7% had stroke in their first degree relative. Serum cholesterol was elevated in 11.7% and LDL in 10.8% patients. Serum Hcy was elevated in 60.6% and serum B12 low in 25.7% and folic acid in 42.1%. Hcy levels correlated with serum B12 and LDL. Patients with hyperhomocysteinemia had significantly better outcome at 3 months. Hcy levels in stroke patients did not significantly differ from controls.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia is found in 60.6% stroke patients, which is related to low serum B12 level. Patients with hyperhomocysteinemia had a better 3-month outcome.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Kumar
authors.forename: Vikas
authors.initials: V
authors.lastname: Bansal
authors.forename: Usha Kant
authors.initials: UK
authors.lastname: Misra
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D014676:Diet, Vegetarian; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000150:complications* / Q000453:epidemiology; D006949:Hyperlipidemias / Q000097:blood / Q000453:epidemiology; D006973:Hypertension / Q000097:blood / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000097:blood / Q000453:epidemiology; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D006710:Homocysteine; D005492:Folic Acid; D014805:Vitamin B 12