(Stroke. 1998;29:2473-2477.)
© 1998 American Heart Association, Inc.
Original Contributions |
Total Homocyst(e)ine Concentration and the Likelihood of Nonfatal Stroke
Results From the Third National Health and Nutrition Examination Survey, 1988–1994
From the Cardiovascular Health Branch, Division of Adult and Community Health (W.H.G., J.B.C., K.J.G.), and the Chronic Disease Nutrition Branch, Division of Nutrition and Physical Activity (E.S.F.), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga, and the Departments of Neurology and Epidemiology and Preventive Medicine (S.J.K.), University of Maryland School of Medicine, Baltimore, Md.
Correspondence and reprint requests to Wayne H. Giles, MD, Cardiovascular Health Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS K-47, Atlanta, GA 30341. E-mail hwg0{at}cdc.gov
Background and Purpose—Elevated serum total homocyst(e)ine [H(e)] is an independent risk factor for stroke. Few studies, however, have examined this association in blacks.
Methods—Data from the Third National Health and Nutrition Examination Survey (n=4534), a nationally representative sample of US adults, were used to examine the relationship between H(e) and a physician diagnosis of stroke (n=185) in both black and white adults. Multivariate-adjusted logistic regression analyses were used to examine this relationship.
Results—Serum vitamin B12 and folate concentrations
were significantly lower among participants in the highest H(e)
quartile (
12.1 µmol/L) than among participants in the lowest
quartile (
7.4 µmol/L). Those in the highest quartile were
older, had higher mean cholesterol and blood pressure
levels, and were more likely to smoke and to have completed <12 years
of education. After adjustment for age, the odds ratio (OR) for stroke
was 2.9 (95% confidence interval [CI], 1.4 to 5.7; highest versus
lowest quartile). Adjustment for gender, race/ethnicity, education,
systolic blood pressure, cholesterol, diabetes
mellitus, and smoking reduced the magnitude of the association (OR,
2.3; 95% CI, 1.2 to 4.6). The association between H(e) and stroke did
not differ by race [P=0.265 for race-H(e) interaction
term]. The multivariate adjusted OR for the highest
quartile versus the lowest was 2.5 (1.1 to 5.5) among whites and 1.4
(0.4 to 4.7) among blacks.
Conclusions—In this nationally representative sample of US adults, H(e) concentration was independently associated with an increased likelihood of nonfatal stroke. This association was present in both black and white adults.
Key Words: epidemiology • homocyst(e)ine • race • stroke
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