Association of Hyperhomocysteinemia with Stroke Recurrence after Initial Stroke.
OBJECTIVE
Homocysteine (Hcy) is closely associated with stroke. Despite the fact that Hcy has consistently been shown to predict development of recurrent stroke, prior studies on the association of Hcy and stroke subtypes have been inconclusive.


METHODS
Data from the Ege Stroke Registry were examined and 5-year follow-up data were analyzed. Multivariate survival analyses were undertaken using Cox proportional hazards models to determine the prognostic value of Hcy in different ischemic stroke subtypes.


RESULTS
Of the 9522 patients with stroke, 307 (27%) with hyperhomocysteinemia (hHcy) had recurrent stroke. Univariate Cox regression model showed that hHcy group was associated with recurrent stroke (crude hazard ratio [HR] 1.16; 95% CI 1.02-1.30). But there was no such association in multivariate regression models (adjusted HR 1.11; 95% CI .97-1.26). hHcy was not associated with any ischemic stroke subtypes at 5 years. Univariate Cox regression model showed that hHcy group was associated with overall cardiovascular events (crude HR 1.44; 95% CI 1.32-1.57). However, this association no longer existed in multivariate regression models (adjusted HR 1.01; 95% CI .93-1.12). Higher plasma Hcy group was significantly associated with higher mortality compared with normal plasma Hcy group (OR 1.83; 95% CI .45-2.32).


CONCLUSIONS
Our results showed that elevated Hcy is not associated independently with stroke recurrence and overall cardiovascular events in patients with ischemic stroke. There was no association between the hHcy and stroke recurrence in the stroke subtypes within 5 years.
Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey. Electronic address: emre.kumral@ege.edu.tr.
Emre
E
Kumral
Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
Gülsüm
G
Saruhan
Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
Dilara
D
Aktert
Biostatistic Department, School of Medicine, Ege University, İzmir, Turkey.
Mehmet
M
Orman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006711:Homocystine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016019:Survival Analysis; D014803:Vitamin B Complex / Q000627:therapeutic use
D014803:Vitamin B Complex; D006711:Homocystine
Homocysteine; large-artery disease; small-artery disease; stroke recurrence