Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: The Framingham Study

Background: Total homocysteine levels are associated with arteriosclerotic outcomes. Objective: To determine whether total homocysteine levels predict incident stroke in elderly persons. Design: Prospective population-based cohort study with 9.9 years of follow- up. Setting: Framingham, Massachusetts. Patients: 1947 Framingham Study participants (1158 women and 789 men; mean age +/- SD, 70 +/- 7 years). Measurements: Baseline total homocysteine levels and 9.9-year stroke incide nce. Results: The quartiles of nonfasting total homocysteine levels were as foll ows: quartile 1, 4.13 to 9.25 mu mol/L; quartile 2, 9.26 to 11.43 mu mol/L; quartite 3, 11.44 to 14.23 mu mol/L; quartile 4, 14.24 to 219.84 mu mol/L. During follow-up, 165 incident strokes occurred. In proportional hazards m odels adjusted for age, sex, systolic blood pressure, diabetes, smoking, an d history of atrial fibrillation and coronary heart disease, relative risk (RR) estimates comparing quartile 1 with the other three quartiles were as follows: quartile 2 compared with quartile 1-RR, 1.32 (95% CI, 0.81 to 2.14 ); quartile 3 compared with quartile 1-RR, 1.44 (CI, 0.89 to 2.34); quartil e 4 compared with quartile 1-RR, 1.82 (CI, 1.14 to 2.91). The linear trend across the quartiles was significant (P < 0.001). Conclusion: Nonfasting total homocysteine levels are an independent risk fa ctor for incident stroke in elderly persons.