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Higher total homocysteine during convalescent phase ups risk of recurrent ischaemic stroke

4 days ago

The risk of recurrent ischaemic stroke is higher in patients with elevated total homocysteine (tHcy) levels during the convalescent phase of acute stroke, a recent study has found.

Researchers measured tHcy levels during acute ischaemia in 2,800 patients, of whom 2,587 had ischaemic stroke (mean age 60.7±10.5 years; 70.0 percent male) and 213 had haemorrhagic stroke (mean age 57.2±10.0 years; 63.4 percent male). THcy levels were measured again 3 months after. Cox proportional hazards regression analysis was performed to determine the relationship between tHcy and recurrent stroke.

Over a median follow-up period of 18 months, 7.9 percent (n=220) of patients had recurrent ischaemic stroke. This risk was highest in patients who belonged to the highest vs lowest quartile of tHcy levels 3 months after acute stroke (adjusted hazard ratio [HR], 1.76; 95 percent CI, 1.11–3.08; p<0.05).

Those in the third vs first quartile of tHcy concentrations at 3 months also had a significantly higher risk of ischaemic stroke reoccurrence (adjusted HR, 1.51; 1.04–2.19; p<0.05). Analysis by type of ischaemia showed that this trend was especially true for patients with large artery atherosclerosis (fourth quartile: adjusted HR, 2.62; 1.29–5.30; third quartile: adjusted HR, 2.11; 1.04–4.28; p<0.05 for both).

In comparison, the fourth (HR, 1.31; 0.91–1.91) and third (HR, 1.28; 0.89–1.86) quartiles of tHcy levels within 3 days of acute stroke did not show heightened risks of recurrent ischaemic stroke.

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