Implications of homocysteine levels and carotid intima-media thickness in Indian stroke patients

Abstract

Background The study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters. The primary objective was to study the correlation of HCY levels with carotid intima-media thickness (IMT) in stroke patients and investigate if HCY levels had any predictive value for the National Institutes of Health Stroke Scale (NIHSS) score. Material and Methods Seventy-eight patients of magnetic resonance imaging or computed tomography scans-confirmed acute ischaemic stroke were recruited for this study, and the NIHSS score was evaluated upon admission. Fasting blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of the neck ascertained IMT of common carotid artery (CCA) and internal carotid artery (ICA). Results The mean age of male and female subjects was 57.88±13.97 and 59.16±13.62 years, respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc), and 24.36% were hyperlipidemic. Patients with NIHSS ≥5 had higher LDL cholesterol than those with NIHSS <5. Positive correlations were found between FBG and CCA IMT and triglyceride and NIHSS. HCY cut off of ≥15 μmol/L had 91.7% sensitivity and 66.7% specificity for predicting NIHSS ≥15. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT and HCY positively correlated with ICA IMT. Conclusions HHcyc state holds a good predictive value for the severity of stroke. We also concluded that ICA IMT measurement may reduce the need for a HCY test as it predicts higher HCY levels, reducing the burden on resources. We suggest that evaluating HCY and ICA IMT should be part of the standard cerebrovascular accident management protocol.