BACKGROUND AND PURPOSE: The level of total homocysteine (tHcy) that confers a risk of ischemic stroke is unsettled, and no prospective cohort studies have included sufficient elderly minority subjects. We investigated the association between mild to moderate fasting tHcy level and the incidence of ischemic stroke, myocardial infarction, and vascular death in a multiethnic prospective study. METHODS: A population-based cohort was followed for vascular events (stroke, myocardial infarction, and vascular death). Baseline values of tHcy and methylmalonic acid were measured among 2939 subjects (mean age, 69+/-10; 61% women, 53% Hispanics, 24% blacks, and 20% whites). Cox proportional models were used to calculate hazard ratios (HRs) and 95% CIs in tHcy categories after adjusting for age, race, education, renal insufficiency, B12 deficiency, and other risk factors. RESULTS: The adjusted HR for a tHcy level > or =15 micromol/L compared with <10 micromol/L was greatest for vascular death (HR=6.04; 95% CI, 3.44 to 10.60), followed by combined vascular events (HR=2.27; 95% CI, 1.51 to 3.43), ischemic stroke (HR=2.01; 95% CI, 1.00 to 4.05), and nonvascular death (HR=2.02; 95% CI, 1.31 to 3.14). Mild to moderate elevations of tHcy of 10 to 15 micromol/L were not significantly predictive of ischemic stroke, but increased the risk of vascular death (2.27; 95% CI, 1.44 to 3.60) and combined vascular events (1.42; 95% CI, 1.06 to 1.88). The effect of tHcy was stronger among whites and Hispanics, but not a significant risk factor for blacks. CONCLUSIONS: Total Hcy elevations above 15 micromol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 micromol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.
BACKGROUND AND PURPOSE: The level of total homocysteine (tHcy) that confers a risk of ischemic stroke is unsettled, and no prospective cohort studies have included sufficient elderly minority subjects. We investigated the association between mild to moderate fasting tHcy level and the incidence of ischemic stroke, myocardial infarction, and vascular death in a multiethnic prospective study. METHODS: A population-based cohort was followed for vascular events (stroke, myocardial infarction, and vascular death). Baseline values of tHcy and methylmalonic acid were measured among 2939 subjects (mean age, 69+/-10; 61% women, 53% Hispanics, 24% blacks, and 20% whites). Cox proportional models were used to calculate hazard ratios (HRs) and 95% CIs in tHcy categories after adjusting for age, race, education, renal insufficiency, B12 deficiency, and other risk factors. RESULTS: The adjusted HR for a tHcy level > or =15 micromol/L compared with <10 micromol/L was greatest for vascular death (HR=6.04; 95% CI, 3.44 to 10.60), followed by combined vascular events (HR=2.27; 95% CI, 1.51 to 3.43), ischemic stroke (HR=2.01; 95% CI, 1.00 to 4.05), and nonvascular death (HR=2.02; 95% CI, 1.31 to 3.14). Mild to moderate elevations of tHcy of 10 to 15 micromol/L were not significantly predictive of ischemic stroke, but increased the risk of vascular death (2.27; 95% CI, 1.44 to 3.60) and combined vascular events (1.42; 95% CI, 1.06 to 1.88). The effect of tHcy was stronger among whites and Hispanics, but not a significant risk factor for blacks. CONCLUSIONS: Total Hcy elevations above 15 micromol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 micromol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.
Authors: Ying Kuen Cheung; Gary Yu; Melanie M Wall; Ralph L Sacco; Mitchell S V Elkind; Joshua Z Willey Journal: Ann Epidemiol Date: 2015-03-23 Impact factor: 3.797
Authors: Liyong Wang; Ashley Beecham; Nicole Dueker; Susan H Blanton; Tatjana Rundek; Ralph L Sacco Journal: Hum Genet Date: 2015-08-30 Impact factor: 4.132
Authors: Ying Kuen Cheung; Yeseon P Moon; Erin R Kulick; Ralph L Sacco; Mitchell S V Elkind; Joshua Z Willey Journal: J Gen Intern Med Date: 2016-10-17 Impact factor: 5.128
Authors: Mitchell S V Elkind; Pankajavalli Ramakrishnan; Yeseon P Moon; Bernadette Boden-Albala; Khin M Liu; Steve L Spitalnik; Tanja Rundek; Ralph L Sacco; Myunghee C Paik Journal: Arch Neurol Date: 2009-11-09
Authors: Joshua Z Willey; Qiang Xu; Bernadette Boden-Albala; Myunghee C Paik; Yeseon Park Moon; Ralph L Sacco; Mitchell S V Elkind Journal: Arch Neurol Date: 2009-11
Authors: Ralph L Sacco; Minesh Khatri; Tatjana Rundek; Qiang Xu; Hannah Gardener; Bernadette Boden-Albala; Marco R Di Tullio; Shunichi Homma; Mitchell S V Elkind; Myunghee C Paik Journal: J Am Coll Cardiol Date: 2009-12-08 Impact factor: 24.094