Homocyst(e)ine and risk of cerebral infarction in a biracial population - The stroke prevention in young women study

Background and Purpose-Genetic enzyme variation and vitamin intake are impo rtant determinants of blood homocyst(e)ine levels. The prevalence of common genetic polymorphisms influencing homocyst(e)ine levels varies by race, an d 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 participa ted 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 4 4 years were compared with 328 controls identified by random-digit dialing from the same region. Risk actor data were collected by standardized interv iew and nonfasting phlebotomy. Plasma homocyst(e)ine was measured by high-p erformance liquid chromatography and electrochemical detection. Results-Blacks and whites did not differ in median homocyst(e)ine levels, n or 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 greater than or equal to 7.3 mu mol/L wa s associated with an odds ratio or 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 vitam in use and poverty status. The degree of homocyst(e)ine elevation associate d with an increased stroke risk in young women is lower than that previousl y reported for middle-aged men and be elderly and was highly prevalent, bei ng present in one third of the control group.