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Lowering Homocysteine Levels May Reduce Stroke Risk in Patients with Peripheral Artery Disease: Presented at ESC

By Adrian Burton

VALENCIA, SPAIN -- May 26, 2003 -- A study from Singapore suggests that lowering homocysteine levels in patients with peripheral artery disease could reduce their stroke risk, according to research presented here May 22^nd at the 12^th European Stroke Conference.

"Several studies have identified moderately elevated homocysteine levels as a risk factor for stroke, but there have been few studies to show which subgroups of patients have elevated homocysteine [levels]," explained Huey Bee Pey, trial co-ordinator at the National Neuroscience Institute, Singapore General Hospital. "Our objective was to examine the relationship between homocysteine and subgroups of ischaemic stroke patients."

The researchers enrolled 115 patients who were admitted to hospital for acute ischaemic stroke and 25 for transient ischaemic attack. They obtained 10-hour fasting blood samples to determine levels of homocysteine, vitamin B12 and folate. Extra and intracranial disease was evaluated by carotid duplex and transcranial colour coded Doppler ultrasound. Peripheral artery disease (PAD) was evaluated using the ankle brachial index, with values below 0.9 being taken to indicate the presence of PAD.

Results of testing show that 62% of patients had significant intra- or extra-cranial disease, 25% had ischaemic heart disease and 17% had PAD; 32% had no significant atherosclerosis in any of the three vascular beds examined; 40% had one bed affected; 25% had two beds affected; and 4% had atherosclerosis in all three beds.

Homocysteine levels increased significantly with vascular bed disease, from 12.6 mcM in patients who had no affected beds, to 17 mcM in those with three beds affected (P=0.024). Interestingly, however, patients with PAD all had increased homocysteine levels (mean of 17.8 mcM compared to 14.6 mcM in non PAD sufferers; P<0.05).

Stepwise regression analysis showed that only age and PAD were predictive of increased homocysteine levels.

Dr. Pey and colleagues concluded that patients with PAD might avoid strokes if their homocysteine levels were brought under control. "This subgroup could derive most benefit from lowering homocysteine levels," Dr. Pey said. "This could be done by treating with vitamin B12."

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