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

17 May 2018

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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