Abstract
ObjectivesTo assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population.MethodsBetween June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models.ResultsCompared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19–1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85–1.53), 1.37 (1.03–1.84) and 1.70 (1.29–2.34), respectively.ConclusionThe present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility to poor outcome among acute ischemic stroke patients in a northern Chinese population.
Highlights
Stroke is the second most common cause of death and the leading cause of serious, long-term disability worldwide [1]
We examined if high homocysteine (hHcy) may increase the risk of poor outcome based on high blood pressure (BP) status in a northern Chinese population
High BP percentage, hospitalized days and SBP were higher in the poor outcome group
Summary
Stroke is the second most common cause of death and the leading cause of serious, long-term disability worldwide [1]. The total incidence of stroke is projected to increase considerably over the two decades [4]. Numerous epidemiological studies have demonstrated a positive association between Hcy level and stroke incidence [6,7,8,9]. A meta-analysis of prospective studies supports the possibility that the association between plasma Hcy and stroke may be causal: a 5 mmol/l Hcy elevation causes a 59% increase in stroke risk, while a 3 mmol/l Hcy reduction leads to a 24% decrease in stroke risk [9]. Previous research has found that elevated Hcy is associated with poor outcome among acute
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