Homocysteine Might Increase the Risk of Recurrence in Patients Presenting with Primary Cerebral Infarction.

PURPOSE: Although hyperhomocysteinemia (Hhcy) is a risk factor for cerebral infarction, its effect on recurrent cerebral infarction is less-defined. We aimed to investigate the association of Hhcy and increased risk of recurrent cerebral infarct.

MATERIALS AND METHODS: From 2011-2013, we recruited 231 primary cerebral infarct patients that were divided to a Hhcy group (n = 105) and a control group (n = 126) according to plasma homocysteinemia (Hcy) levels exceeding 15μmol/L. In this prospective study, risk factors like gender, age, blood lipid and glucose levels, history of diabetes, high blood pressure, smoking habits, and plasma Hhcy levels were determined. A three-year follow-up compared differences in cerebral infarction recurrence rates. Statistical analyses identified whether plasma Hhcy levels were an independent risk factor for recurrent cerebral infarction.

RESULTS: Triglyceride and low density lipoprotein (LDL) levels in the Hhcy group were significantly higher than controls, and cerebral infarct recurrence rates in the Hhcy group exceeded control subject rates through the three-year follow-up (P = 0.021, P = 0.036, and P = 0.025). Cox proportional hazards modeling showed that elevated Hhcy levels (Hazard ratio [HR] = 3.062, P<0.001), increased age (HR = 1.069, P<0.01), circulating triglyceride levels (HR = 1.686, P = 0.048), and relative National Institutes of Health Stroke (NIHSS) score (HR = 1.068, P = 0.016) were risk factors for recurrent cerebral infarction.

CONCLUSIONS: Level of Hhcy was a risk factor for recurrent cerebral infarction. Further, particular demographic and clinical outcomes including age, relative NIHSS scores, and circulating triglyceride levels were markedly associated with the occurrence of cerebral infarction.