Hyperhomocysteinaemia among Acute Ischaemic Stroke Patients in a Tertiary Care Centre in Thiruvananthapuram, Kerala – A Cross-Sectional Study

Abstract

BACKGROUND Over the last three decades, prevalence of stroke has been high in India, while the Western countries have witnessed a downward slide. Epidemiological studies suggest that hyperhomocysteinaemia might be a potentially modifiable nonlipid risk factor associated with stroke, in addition to the long-recognized factors like hypertension, diabetes mellitus, hyperlipidaemia and smoking. Hyperhomocysteinaemia occurs due to deviation in the metabolic pathway of methionine, attributed by deficiency of vitamins, enzymes and other factors. The present study was undertaken to assess the proportion of hyperhomocysteinaemia in patients with acute ischemic stroke. We also compared the risk factors associated with stroke and serum levels of homocysteine. METHODS This is a cross sectional observational study conducted in a tertiary care hospital. The sample size was 140. Both male and female consecutive patients of age more than 18 years, with first attack of acute ischaemic stroke admitted in the Department of Neurology were selected. Baseline fasting serum samples were obtained for testing serum homocysteine levels. Statistical tests used were proportion, chi square and logistic regression. RESULTS Among 140 acute ischaemic stroke patients, total homocysteine level was raised in 83.6 % cases. The prevalence of moderate hyperhomocysteinaemia in our study was 65.4 % and intermediate hyperhomocysteinaemia was 17.9 % among stroke patients. The mean (± SD) homocysteine level was 22.75 (± 8.19). CONCLUSIONS A strong association was found between hyperhomocysteinaemia and acute ischaemic stroke. We could not find any significant correlation between total homocysteine level and most risk factors of stroke. KEYWORDS Stroke, Homocysteine, Risk Factors, Endothelial Dysfunction, Atherosclerosis, B Vitamins