Relationship Between Homocysteine and Carotid Artery Stenosis in Ischemic Stroke

Abstract:
Background: Epidemiologic studies have identified hyper-homocysteinemia as a
possible risk factor for atherosclerosis. The aim of my study was based on evaluation of
relationship between homocysteinemia with carotid artery stenosis in ischemic stroke
patients.

Methods and materials: It was a prospective observational study conducted in
the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka.
Thirty six consecutive patients with ischemic stroke were analyzed by serum total
homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and
extracranial Doppler ultrasonography and vascular risk factors were recorded. Equal
number of controls of same ages were compared with the case group.

Result: Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density
lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL
had a positive correlation with serum homocystine (p=0.001). Serum High density lipoprotein
(HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative
correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89
± 9.38 ìmol/l and control group was 12.31 ± 3.27 ìmol/l, (p=0.001). Elevated fasting
homocysteine level was found in 75.0% of the ischemic stroke patients and in 16.67% of
healthy controls (p=0.001).On the basis of clinical evaluation and results of imaging studies,
etiological classification of the ischemic stroke patients were made, where 36.1% cases
were small artery disease, 38.9% large artery disease, 8.3% cases cardioembolic and in
16.7 % other causes. Among the cases, carotid duplex study was found normal in seven
cases (19.4%), Group 1 findings in seven cases (19.4%), group 2 findings in eight cases
(22.2%), group 3 findings in thirteen cases (36.1%) and group 4 findings in one case
(2.8%). All abnormal carotid duplex findings were significantly higher among cases with
elevated level of homocysteine (p=0.001, 0.001, 0.001) .Conclusion: The incidence of
hyperhomo-cysteinemia is higher in ischaemic stroke cases than that in age-sex matched
healthy controls. Hyperhomocysteinemia in ischaemic stroke patients has been determined
as vascular risk factor in our study. Significant correlation has been found between
homocysteine concentration and intraluminal thickness and carotid artery stenosis.