TOTAL HOMOCYST(E)INE CONCENTRATION AND THE LIKELIHOOD OF NONFATAL STROKE - RESULTS FROM THE 3RD NATIONAL-HEALTH AND NUTRITION EXAMINATION SURVEY, 1988-1994

Background and Purpose-Elevated serum total homocyst(e)ine [H(e)] is a n independent risk factor for stroke. Few studies, however, have exami ned this association in blacks. Methods-Data from the Third National H ealth and Nutrition Examination Survey (n=4534), a nationally represen tative sample of US adults, were used to examine the relationship betw een 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 B-12 and fol ate concentrations were significantly lower among participants in the highest H(e) quartile (greater than or equal to 12.1 mu mol/L) than am ong participants in the lowest quartile (less than or equal to 7.4 mu mol/L). Those in the highest quartile were older, had higher mean chol esterol and blood pressure levels, and were more likely to smoke and t o 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 m ellitus, 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 multivar iate 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) concentra tion was independently associated with an increased likelihood of nonf atal stroke. This association was present in both black and white adul ts.