title: Elevated homocysteine and carotid plaque area and densitometry in the Northern Manhattan Study.
abstract: OBJECTIVE
  Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort.
  
  
  METHODS
  In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66 ± 9; 41% men; 19% black; 62% Hispanic; 17% white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B(12) deficiency.
  
  
  RESULTS
  The mean tHcy was 9.4 ± 4.8 µmol/L (median=8.6). The prevalence of carotid plaque was 57% (52% among Hispanics, 58% black, and 70% white). Among those with plaque, the mean TPA was 20.3 ± 20.6 mm(2) (median=13.6) and mean GSM 90.9 ± 28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95% confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95% CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95% CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95% CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95% CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95% CI, 1.3-3.7]).
  
  
  CONCLUSIONS
  In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.
authors.affiliation: Department of Neurology, Miller School of Medicine, University of Miami, Clinical Research Bldg 1120, NW 14 St, Miami, FL 33136, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Alsulaimani
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ken
authors.initials: K
authors.lastname: Cheung
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016893:Carotid Stenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003720:Densitometry / Q000379:methods; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D006710:Homocysteine