Sacco Ralph L, Anand Kishlay, Lee Hye-Seung, Boden-Albala Bernadette, Stabler Sally, Allen Robert, Paik Myunghee C
Department of Neurology, Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY, USA.
Stroke. 2004 Oct;35(10):2263-9. doi: 10.1161/01.STR.0000142374.33919.92. Epub 2004 Sep 2.
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.
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.
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.
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.
导致缺血性卒中风险的总同型半胱氨酸（tHcy）水平尚无定论，且尚无前瞻性队列研究纳入足够数量的老年少数族裔受试者。我们在一项多民族前瞻性研究中调查了轻度至中度空腹tHcy水平与缺血性卒中、心肌梗死及血管性死亡发生率之间的关联。
对一个基于人群的队列进行血管事件（卒中、心肌梗死和血管性死亡）随访。在2939名受试者（平均年龄69±10岁；61%为女性，53%为西班牙裔，24%为黑人，20%为白人）中测量tHcy和甲基丙二酸的基线值。采用Cox比例模型在调整年龄、种族、教育程度、肾功能不全、维生素B12缺乏及其他危险因素后计算tHcy各分类中的风险比（HRs）及95%置信区间（CIs）。
与tHcy水平<10 μmol/L相比，tHcy水平≥15 μmol/L时调整后的HR在血管性死亡方面最高（HR = 6.04；95% CI，3.44至10.60），其次是合并血管事件（HR = 2.27；95% CI，1.51至3.43）、缺血性卒中（HR = 2.01；95% CI，1.00至4.05）和非血管性死亡（HR = 2.02；95% CI，1.31至3.14）。tHcy轻度至中度升高至10至15 μmol/L对缺血性卒中无显著预测价值，但增加了血管性死亡风险（2.27；95% CI，1.44至3.60）和合并血管事件风险（1.42；95% CI，1.06至1.88）。tHcy的影响在白人和西班牙裔中更强，但对黑人而言并非显著危险因素。
tHcy升高至15 μmol/L以上是缺血性卒中的独立危险因素，而tHcy轻度升高至10至15 μmol/L时预测价值较小。tHcy对血管的影响在白人和西班牙裔中最大，在黑人中较小。
