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

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  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

  Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 17, No. 2, Year 2008 (Cover Date: February 2008)

Journal Editor: Owunwanne, A. (Kuwait)
ISSN: 1011-7571 (Print), eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP

  Drug Dosage / Copyright

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.