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Homocysteine testing in patients with acute ischemic stroke

From the Department of Medicine (Neurology) (Drs. Bushnell and Goldstein), Duke Center for Cerebrovascular Disease (Drs. Bushnell and Goldstein), and Center for Clinical Health Policy Research (Dr. Goldstein), Duke University Medical Center, and VA Medical Center (Dr. Goldstein), Durham, NC.

Address correspondence and reprint requests to Dr. Cheryl Bushnell, P.O. Box 2900, Duke University Medical Center, Durham, NC 27710; e-mail: bushn002{at}mc.duke.edu

Objective: To determine pretesting factors associated with elevated total homocysteine (tHcy) levels in a cohort of patients with acute ischemic stroke and to identify patient characteristics associated with physicians’ decisions to obtain tHcy levels in routine clinical practice.

Methods: Patient demographics, traditional stroke risk factors, and the results of tHcy tests were recorded for a consecutive series of adult patients with ischemic stroke admitted to an academic medical center from January 1997 to December 1999 (n = 674). Stroke subtype was classified using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Univariate analyses were used to identify patient characteristics associated with elevated tHcy levels and factors associated with tHcy testing. Multivariable stepwise logistic regression analyses were then used to identify the independent associations of univariately significant variables with tHcy testing.

Results: Of 674 patients, 131 (19.4%) were tested for tHcy. There were no associations between age, sex, stroke subtype, or the presence of other stroke risk factors and tHcy levels. Younger age (odds ratio [OR] = 0.54/decade, 95% CI = 0.46 to 0.62), the presence of hyperlipidemia (OR = 1.9, 95% CI = 1.2 to 2.9), diabetes (OR = 0.47, 95% CI = 0.29 to 0.78), and cardioembolic (OR = 0.47, 95% CI = 0.23 to 0.95) and small-vessel (OR = 0.43, 95% CI = 0.22 to 0.83) stroke subtypes were independently associated with tHcy testing.

Conclusions: Elevated tHcy levels were not associated with any of the studied characteristics of ischemic stroke patients. More research is needed to determine factors that aid in selecting patients for tHcy testing and improving diagnostic yield.