Original Paper

Determinants and Associations of Homocysteine and Prothrombotic Risk Factors in Kuwaiti Patients with Cerebrovascular Accident
Olusegun A. Mojiminiyi^a, Rajaa Marouf^a, Abdel Raoof Al Shayeb^c, Mohammad Qurtom^c, Nabila A. Abdella^b, Hanan Al Wazzan^c, Salah Al Humood^a, Majeda Abdul Samad^c, Hadeel El-Muzaini^a

Departments of
^aPathology and
^bMedicine, Faculty of Medicine, Kuwait University, and
^cMubarak Al-Kabeer Hospital, Kuwait

Address of Corresponding Author

Med Princ Pract 2008;17:136-142 (DOI: 10.1159/000112968)

  Key Words

• Cerebrovascular accident
• Homocysteine
• Prothrombotic risk factors

  Abstract

Objective: The objective ofthis study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents (CVAs). Subjects and Methods:In this case-control study, plasma total homocysteine (tHcy), lupus anticoagulant, protein C, protein S, activated protein C resistance (APC-R) and antithrombin were measured in 102 patients (60 males and 42 females) and 167 controls (87 males, 80 females). Serum vitamin B₁₂, folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate (GFR) was calculated. Results:13 (22%) of the 60 male patients, and 16 (39%) of the 42 female patients had hyperhomocysteinemia. Median (interquartile range) tHcy was higher in male patients [11.22 µmol/l (9.60-15.40)] than female patients [10.05 µmol/l (8.72-17.54)]. On binary logistic regression analysis, the significant (p < 0.05) determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B₁₂ and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA (OR = 9.55; p = 0.047) in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females. Conclusion:Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors (protein C, APC-R and factor VIII) to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Olusegun A. Mojiminiyi
Department of Pathology, Kuwait University
PO Box 24923
Safat 13110 (Kuwait)
Tel. +965 498 6281, Fax +965 533 8905, E-Mail segunade@yahoo.com

  Article Information

Received: February 3, 2007
Revised: May 15, 2007
Published online: February 19, 2008
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 2, Number of References : 39