title: Homocysteine level and risk of different stroke types: a meta-analysis of prospective observational studies.
abstract: OBJECTIVE
  Inconsistent findings have been reported regarding the association between elevated plasma homocysteine (Hcy) levels and the risk of different types of strokes. We conducted this meta-analysis to identify the association between homocysteine (Hcy) levels and different kinds of strokes or recurrences of strokes.
  
  
  RESULTS
  PubMed and Embase databases were searched for relevant studies published prior to April 2013. Only prospective studies that compared elevated Hcy levels with the risk of different types of strokes were selected. Results were presented as the relative risk (RR) and the corresponding 95% confidence intervals (CI) comparing the highest Hcy category group with the lowest Hcy category group. Nine studies composed of 13,284 participants were included. The pooled RR of ischemic strokes when comparing the highest Hcy category group with the lowest Hcy category group was 1.69 (95% CI: 1.29-2.20) in a fixed-effect model. The pooled RR of hemorrhagic strokes and recurrent strokes when comparing the highest Hcy category group with the lowest Hcy category group in a fixed-effect model was 1.65 (95% CI: 0.61-4.45) and 1.76 (95% CI: 1.37-2.24), respectively.
  
  
  CONCLUSIONS
  This meta-analysis indicated that elevated Hcy levels are associated with an increased risk for ischemic strokes and recurrent strokes but had no distinct association with hemorrhagic strokes.
authors.affiliation: Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China.
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China. Electronic address: Niezhiyushh@126.com.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Nie
mesh_terms: D016208:Databases, Factual; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D064887:Observational Studies as Topic; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000097:blood*
chemical_list: D006710:Homocysteine
keywords: Homocysteine; Ischemic stroke; Stroke