Hyperhomocyst(e)inemia is a risk factor of secondary vascular events in stroke patients.

OBJECTIVE: Moderate hyperhomocyst(e)inemia is an independent risk factor for stroke, but it is unclear whether it also would be a risk factor for secondary vascular events after stroke. METHODS: Longitudinal study of 137 consecutive ischemic stroke patients (age 45-91 years) who were prospectively studied with a standard clinical protocol. Vascular events (stroke recurrence, ischemic heart disease, deep venous thrombosis or peripheral arterial disease) were identified during 2 years of follow-up. Serum homocyst(e)ine was determined 3 months after the stroke. The cumulative proportion of patients with homocyst(e)ine above or below the 75th percentile who survived free of vascular events was determined by Kaplan-Meier analysis. Cox models were used to estimate the relative risk of vascular events after controlling for other confounding factors. RESULTS: Serum homocyst(e)ine was significantly higher in patients with vascular events (26.2 versus 19.4 micromol/l; p = 0.016). The cumulative proportion of patients with vascular events was 46.5% in the group with homocyst(e)ine over the 75th percentile (>30 micromol/l) and 20.2% in the other group (log-rank test 7.5; p = 0.0062). After adjustment for age, sex, high blood pressure, diabetes, heart disease, previous cerebrovascular disease, smoking and serum cholesterol, the relative risk of vascular event for patients above compared with those below the 75th percentile of serum homocyst(e)ine was 2.8 (CI 95% 1.3-6; p = 0.01). CONCLUSION: Hyperhomocyst(e)inemia is a significant risk factor for vascular events after ischemic stroke. This finding is independent of other risk factors such as hypertension, and may have therapeutic relevance in the secondary prevention of vascular diseases in stroke patients.

[Plasma levels of vitamins A and E and the risk of acute myocardial infarct]. / Niveles plasmáticos de vitaminas A y E y riesgo de infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVE: The incidence of myocardial infarction in Spain is low in spite of the high prevalence of smoking and hypertension. Natural antioxidants as vitamin E from a diet rich in fruit, oils and vegetables may protect against the development of this disease. In this study we have examine plasma levels of vitamin A and E as risk factors in the development of myocardial infarction. STUDY DESIGN: 62 cases were selected among patients 30-70 years old admitted to the hospital with a first episode of myocardial infarction, or diagnosed by arteriography of coronary heart disease. 62 controls were selected among patients with minor surgical conditions, and free of coronary heart disease according to the Rose questionnaire and ECG. LABORATORY ANALYSIS: Plasma samples for vitamin assays were taken in the first 24 hours after admission (62 cases) Plasma was separated by centrifugation and stored at -80 degrees C until plasma vitamins were determined by HPLC. RESULTS: Lipid adjusted blood levels of vitamin E were lower in cases, mean: 1092.0 +/- standard deviation 165.8 micrograms/dl (mean +/- SD) than in controls (1220.1 +/- 274.8 micrograms/dl p = 0.002). The multivariate adjusted odds ratio between extreme quintiles of blood vitamin E were 0.06 (95% confidence intervals (CI): 0.01-0.5; p for trend 0.0027. Adjusted blood levels of vitamins A were also lower in cases 44.0 +/- 15.1 micrograms/dl than in controls: (57.5 +/- 15.2 micrograms/dl; p < 0.001). Adjusted odds ratio between extreme quintiles of blood vitamin A adjusted for confounding factors were 0.06 (95% CI: 0.01-0.36; p for trend < 0.00001). CONCLUSIONS: There is an association between acute of myocardial infarction and reduce blood levels of vitamin A and E, that is not explained by the decrement in blood lipids levels. Therefore low blood levels of fat soluble vitamins may be a risk factor for the development of this disease.