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(Stroke. 1999;30:1554-1560.)
© 1999 American Heart Association, Inc.

Original Contributions

Homocyst(e)ine and Risk of Cerebral Infarction in a Biracial Population

The Stroke Prevention in Young Women Study

Steven J. Kittner, MD, MPH; Wayne H. Giles, MD, MS; Richard F. Macko, MD; J. Richard Hebel, PhD; Marcella A. Wozniak, MD, PhD; Robert J. Wityk, MD; Paul D. Stolley, MD, MPH; Barney J. Stern, MD; Michael A. Sloan, MD; Roger Sherwin, MB, BChir; Thomas R. Price, MD; Robert J. McCarter, ScD; Constance J. Johnson, MD; Christopher J. Earley, MD, PhD; David W. Buchholz, MD M. Rene Malinow, MD

From the Departments of Neurology (S.J.K, R.F.M., M.A.W.) and Epidemiology and Preventive Medicine (S.J.K., J.R.H., R.J.M., T.R.P., P.D.S.), University of Maryland at Baltimore; Geriatrics Research, Education, and Clinical Center, Baltimore Department of Veterans Affairs Medical Center (Md) (S.J.K., R.F.M); Department of Neurology, Johns Hopkins University, Baltimore, Md (D.W.B., C.J.E., C.J.J., R.J.W.); Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (W.H.G.); Department of Neurology, Emory University, Atlanta, Ga (B.J.S.); Department of Neuroscience, Harbin Clinic, Rome, Ga (M.A.S.); Tulane School of Public Health and Tropical Medicine, New Orleans, La (R.S.); and Laboratory of Cardiovascular Diseases, Oregon Primate Research Center, Beaverton (M.R.M.).

Background and Purpose—Genetic enzyme variation and vitamin intake are important determinants of blood homocyst(e)ine levels. The prevalence of common genetic polymorphisms influencing homocyst(e)ine levels varies by race, and vitamin intake varies by socioeconomic status. Therefore, we examined the effect of vitamin intake, race, and socioeconomic status on the association of homocyst(e)ine with stroke risk.

Methods—All 59 hospitals in the greater Baltimore-Washington area participated in a population-based case-control study of stroke in young women. One hundred sixty-seven cases of first ischemic stroke among women aged 15 to 44 years were compared with 328 controls identified by random-digit dialing from the same region. Risk factor data were collected by standardized interview and nonfasting phlebotomy. Plasma homocyst(e)ine was measured by high-performance liquid chromatography and electrochemical detection.

Results—Blacks and whites did not differ in median homocyst(e)ine levels, nor did race modify the association between homocyst(e)ine and stroke. After adjustment for cigarettes per day, poverty status, and regular vitamin use, a plasma homocyst(e)ine level of 7.3 µmol/L was associated with an odds ratio for stroke of 1.6 (95% CI, 1.1 to 2.5).

Conclusions—The association between elevated homocyst(e)ine and stroke was independent not only of traditional vascular risk factors but also of vitamin use and poverty status. The degree of homocyst(e)ine elevation associated with an increased stroke risk in young women is lower than that previously reported for middle-aged men and the elderly and was highly prevalent, being present in one third of the control group.

Key Words: case-control studies • cerebrovascular disorders • homocysteine • risk factors • vitamins

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