Elevated Total Homocysteine Levels in Acute Ischemic Stroke Are Associated With Long-Term Mortality

You'll have to see what your doctor does with this information to reduce your risk of dying.
An updated stroke protocol on not dying would be the best.
http://stroke.ahajournals.org/content/46/9/2419.abstract

1. Zhihong Shi, MD, PhD;
2. Yalin Guan, MD, MS;
3. Ya Ruth Huo, BA, MD;
4. Shuling Liu, RN, MS;
5. Meilin Zhang, PhD;
6. Hui Lu, MD, MS;
7. Wei Yue, MD, MS;
8. Jinhuan Wang, MD, PhD;
9. Yong Ji, MD, PhD

+ Author Affiliations

1. From the Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases (Z.S., Y.G., S.L., H.L., W.Y., J.W., Y.J.), Department of Neurology (Z.S., Y.G., S.L., H.L., W.Y., Y.J.), and Department of Neurosurgery (J.W.), Tianjin Huanhu Hospital, Tianjin, China; School of Medicine, University of New South Wales, Kensington, NSW, Australia (Y.R.H.); and Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China (M.Z.).

1. Correspondence to Yong Ji, MD, PhD, Department of Neurology, Tianjin Huanhu Hospital, Qixiangtai Rd 122, Hexi, Tianjin 300060, China. E-mail jiyongusa@126.com

Abstract

Background and Purpose—Total homocysteine (tHcy) levels are associated with secondary vascular events and mortality after stroke. The aim of this study was to investigate whether tHcy levels in the acute phase of a stroke contribute to the recurrence of cerebro-cardiovascular events and mortality.

Methods—A total of 3799 patients were recruited after hospital admission for acute ischemic stroke. Levels of tHcy were measured within 24 hours after primary admission. Patients were followed for a median of 48 months.

Results—During the follow-up period, 233 (6.1%) patients died. After adjustment for age, smoking status, diabetes mellitus, and other cardiovascular risk factors, patients in the highest tHcy quartile (>18.6 μmol/L) had a 1.61-fold increased risk of death (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.03–2.53) compared with patients in the lowest quartile (≤10 μmol/L). Further subgroup analysis showed that this correlation was only significant in the large-artery atherosclerosis stroke subtype (adjusted HR, 1.80; 95% CI, 1.05–3.07); this correlation was not significant in the small-vessel occlusion subtype (adjusted HR, 0.80; 95% CI, 0.30–2.12). The risk of stroke-related mortality was 2.27-fold higher for patients in the third tHcy quartile (adjusted HR, 2.27; 95% CI, 1.06–4.86) and 2.15-fold more likely for patients in the fourth quartile (adjusted HR, 2.15; 95% CI, 1.01–4.63) than for patients in the lowest tHcy quartile. The risk of cardiovascular-related mortality and the risk of recurrent ischemic stroke were not associated with tHcy levels.

Conclusions—Our findings suggest that elevated tHcy levels in the acute phase of an ischemic stroke can predict mortality, especially in stroke patients with the large-vessel atherosclerosis subtype.