Homocysteine in cerebrovascular disease: An independent risk factor for subcortical vascular encephalopathy

Hyperhomocysteinemia is a risk factor for obstructive large-vessel disease. Here, we studied plasma concentrations of homocysteine and vitamins in pat ients suffering from subcortical vascular encephalopathy (SVE), a cerebral small-vessel disease leading to dementia. These results were compared to th e homocysteine and vitamin plasma concentrations from patients with cerebra l large vessel disease and healthy control subjects. Plasma concentrations of homocysteine, vascular risk factors and vitamin st atus (B-6, B-12, folate) were determined in 82 patients with subcortical va scular encephalopathy, in 144 patients with cerebral large-vessel disease a nd in 102 control subjects. Patients with SVE, but not those with cerebral large-vessel disease, exhibited pathologically increased homocysteine conce ntrations in comparison with control subjects without cerebrovascular disea se. Patients with SVE also showed lower vitamin B6 values in comparison to subjects without cerebrovascular disease. Logistic regression analysis show ed that homocysteine is associated with the highest risk for SVE (odds rati o 5.7; CI 2.5-12.9) in comparison to other vascular risk factors such as hy pertension, age and smoking. These observations indicate that hyperhomocysteinemia is a strong independe nt risk factor for SVE.