Importance of Raised Serum Homocysteine Levels in Ischemic Stroke Patients

Abstract

Background: Around 5.5 million people die from stroke each year, making it the second leading cause of mortality worldwide. Increased homocysteine levels lead to early neurological deteriorations in ischemic stroke and may have an association with other risk factors of stroke. Objective: To determine how closely homocysteine levels are associated with other risk factors for ischemic stroke. Methods: This is a cross-sectional study, which was performed in the Department of Neurology, Liaquat National Hospital, Karachi from January to December 2021. All ischemic stroke patients of either gender above the age of 16 were included. Ischemic stroke was identified by neuroimaging MRI in patients presenting with focal neurological deficits lasting more than 24 hours. For statistical analysis, data was entered into SPSS version 21. Results: A total of 100 patients were included in the study with a mean age of 56.8 ± 15.6 years. Most of the patients were males (65%). Hypertension and diabetes were present in 76% and 42% of patients respectively. 45% of patients had homocysteine levels <15 μmol/l while 55 % had raised homocysteine levels. Amongst them, 42% had levels of homocysteine in the range of 15-30 μmol/l (mild) whereas 13% had >30 μmol/l homocysteine levels (intermediate). None of them had a level >100 μmol (severe). On univariate analysis, the odds of increasing homocysteine levels were higher in males than females. Increasing B12 levels were associated with decreased odds of intermediate homocysteine levels. On the multivariable model after adjusting the model with other covariates, increasing B12 levels remained associated with homocysteine levels with a lower likelihood of intermediate homocysteine levels. Conclusion: According to the results of our study, there is a strong correlation between high homocysteine levels and low B12 levels, making homocysteine a substantial risk factor for ischemic stroke. Vitamin B12 has a major role in homocysteine pathomechanisms and its deficiency predisposes to hyperhomocysteinemia and hence stroke. Larger multicenter studies may be done to evaluate the role of B12 as a homocysteine-lowering agent both for the treatment and prevention of ischemic stroke.