a1 County Hospital, Griffithstown, Pontypool, Wales, UK
a2 Caerphilly Miners' Hospital, Caerphilly, Wales, UK
a3 Nevill Hall Hospital, Abergavenny, Wales, UK
a4 Royal Gwent Hospital, Newport, Gwent, Wales, UK
Interest in homocysteine's role in vascular disease was stimulated by the paper of McCully (1969) in which, based on autopsy evidence of extensive arterial thrombosis in two children with elevated plasma homocysteine concentrations and homocystinuria, he proposed that elevated plasma homocysteine (hyperhomocysteinaemia) can cause atherosclerotic vascular disease. A meta-analysis of subsequent prospective observational studies concluded that elevated homocysteine is indeed a modest independent predictor of ischaemic heart disease and stroke risk in healthy populations with a 25% reduction in serum homocysteine concentration, a reduction of approximately 3 micromol per litre (μmol/l) being associated with a 19% lower risk of stroke (odds ratio, 0.81; 95% confidence interval (CI), 0.69 – 0.95). In the nationally representative sample of US adults, elevated homocysteine concentration was independently associated with an increased likelihood of non-fatal stroke in both black and white adults. In this article, the current concepts relating homocysteine to ischaemic stroke are reviewed.
c1 Address for correspondence: Khin Zaw, Torfaen Intermediate Care, County Hospital Coed-Y-Gric, Griffithstown, Pontypool, NP4 5YA, Wales, UK.