Plasma homocysteine is a risk factor
for recurrent vascular events in young
patients with an ischaemic stroke or TIA |
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Authors: | Michiel?J?Bos Mary-Lou?P?J?van?Goor Peter?J?Koudstaal Email author" target="_blank">Diederik?W?J?DippelEmail author |
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Institution: | (1) Dept. of Neurology, Erasmus MC, 1738, 3000 DR Rotterdam, The Netherlands |
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Abstract: | Objectives
Young patients
with an ischaemic stroke or
transient ischaemic attack (TIA)
often have no vascular risk factors.
Hyperhomocysteinaemia is an
established risk factor for stroke in
elderly patients but it is uncertain
whether it is also important for the
prognosis of young ischaemic
stroke and TIA patients. We examined
the possible effect of the
plasma homocysteine level on the
risk of recurrent vascular events in
patients between 18 and 45 years of
age.
Methods
The study population
consisted of 161 consecutive patients
with a recent cerebral infarction
or TIA. Data on the primary
event and the homocysteine level
were collected retrospectively from
hospital records. General practitioners
and patients were contacted
by telephone to record vascular
events and the type of medication
used during the follow–up period.
Vascular events included cerebral
infarction, TIA, pulmonary embolism,
venous thrombosis, myocardial
infarction and peripheral
arterial disease.
Results
A Kaplan-
Meier curve showed a dose effect
relationship between event-free
survival time and tertiles of the
homocysteine level (Log rank
statistic 5.91; p = 0.05). The Cox
hazard ratio, after adjustment for
homocysteine lowering treatment,
was 1.7 (95 % CI, 1.1 to 2.8) for any
vascular outcome event, 1.9 (95%
CI, 1.1 to 3.0) for arterial outcome
events and 1.8 (95 % CI, 1.1 to 2.9)
for cerebral outcome events.
Conclusions
In spite of our small number
of outcome events we found a
significant association at the 95%
confidence level between homocysteine
level and the risk of recurrent
vascular events in young patients
with an ischaemic stroke or TIA.
The association is of the same
magnitude as in elderly people. |
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Keywords: | homocysteine brain infarction ischaemic attack transient |
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