Elevated levels of total homocysteine after ischemic stroke: a potential marker for in-hospital outcomes

ABSTRACT

Objectives

Our goal was to determine the risk conferred by elevated total homocysteine (tHcy) levels on recurrent stroke and cardiovascular disease (CVD) events after an ischemic stroke (IS), using data from the Chinese Stroke Center Alliance (CSCA).

Methods

The study consisted of 746,854 total participants with IS. Subjects were split into groups as well as quartiles according to tHcy level. Groups included a hyperhomocysteinemia (HHcy) group with tHcy ≥15 μmol/l and a normohomocysteinemia group (nHcy) with tHcy <15 μmol/l. The determined groups and quartiles underwent multiple logistic regression models with nHcy or quartile 1 as reference groups, respectively. The information from these analyses was adjusted for potential covariates and used to investigate the association between blood tHcy and in-hospital outcomes. Information collected at discharge included in-hospital stroke recurrence and CVD events.

Results

The mean [SD] age of participants was 66.2 [12.0] and 37.4% (n = 279,571) were female. The median hospital duration was 11.0 days (interquartile range, 8.0–14.0 days) and 343,346 (46.0%) patients were identified as HHcy cases (tHcy ≥15 μmol/). According to the tHcy quartile, the cumulative rates of stroke recurrence (from lowest quartile to highest) were 5.2%, 5.6%, 6.1%, and 6.6% (P < 0.0001). Similarly, those of CVD events were 5.8%, 6.1%, 6.7%, and 7.2% (P < 0.0001). Compared with the nHcy group, the HHcy group was associated with increased risks of in-hospital stroke recurrence (21912 [6.4%] vs. 22048 [5.5%], with the adjusted odds ratio (OR) 1.08, 95% CI: 1.05 to 1.10) as well as CVD events (24001 [7.0%] vs. 24236 [6.0%], with the adjusted OR: 1.08, 95% CI: 1.06 to 1.10) among patients with IS in the fully adjusted model.

Conclusion

HHcy was associated with increased in-hospital stroke recurrence and CVD events among patients with IS. In low-folate regions, tHcy levels may potentially predict in-hospital outcomes after IS.

KEYWORDS:

• Cardiovascular disease (CVD)
• the Chinese stroke center alliance (CSCA)
• multiple logistic regression analyses
• hyperhomocysteinemia
• normohomocysteinemia

Acknowledgements

The authors thank all participating centers in the Chinese Stroke Center Alliance program for their hard work in data collection. The authors are grateful for the great help in proof-reading by Roxanne Ilagan, at Wayne State University School of Medicine, USA.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributors

W Liu and XL Ma drafted the manuscript. HQ Gu did the data analysis. H Li served as a scientific advisor and oversaw all scientific aspects of its implementation. ZX Li critically reviewed and revised the whole manuscript. CJ Wang and X Yang collected and managed the data. YJ Wang has full access to and takes full responsibility for the data, the analyses, and interpretation, as well as the conduct of the research.

Data availability statement

Data is available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China (81870905U20A20358) and grants from Beijing Municipal Science & Technology Commission (D171100003017002).