Elevated plasma homocysteine level is associated with ischemic stroke in Chinese hypertensive patients

• We evaluated the association of homocysteine and ischemic stroke and coronary heart disease in hypertensive patients.
• Homocysteine is positively associated with the presence of ischemic stroke but not coronary heart disease.
• Homocysteine level was higher in men than in women.

BackgroundAccumulating data suggest that hyperhomocysteinemia is associated with the risk of ischemic stroke (IS) and coronary heart disease (CHD) in the general population, but the relationship remains unclear in hypertensive patients. We examined the association of total homocysteine (tHcy) with IS and CHD in hypertensive patients.MethodsA total of 5935 Chinese hypertensive patients were recruited in a community-based cross-sectional study from 60 communities in Shenzhen, China. Plasma tHcy was quantitatively measured using the enzyme cycle method. Conventional risk factors for IS and CHD were obtained through questionnaire interviews and physical examinations. We included cerebral infarction, embolism and small-vessel disease as IS; and myocardial infarction, angina pectoris, coronary revascularization, and cardiac arrest as CHD. IS and CHD were retrospectively adjudicated by specialists via interviews, hospital records or relevant tests.ResultsSignificantly higher values of tHcy were observed in IS patients than in non-IS controls among both men and women. Greater tHcy level was dose dependently associated with an increased risk of IS presence in women, men and them combined (p-trend: 0.002, 3.8 × 10− 4 and 0.001). The odds ratios (95% CI) of IS for tHcy ≥ 30 (vs. < 15) μmol/L were 2.84 (1.73–4.34) in men, 4.41 (1.62–9.15) in women, and 2.86 (1.72–4.75) in their combination after adjusting for other main risk factors of IS. We did not find any significant association between tHcy and presence of CHD after the adjustment for covariates.ConclusionsPlasma homocysteine level is positively associated with the presence of IS, but not CHD, in Chinese hypertensive patients.