Elevated homocysteine and carotid plaque area and densitometry in the northern Manhattan study

Sara Alsulaimani, Hannah Gardener, Mitchell S V Elkind, Ken Cheung, Ralph L Sacco, Tatjana Rundek

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - : Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort. METHODS - : In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66±9; 41% men; 19% black; 62% Hispanic; 17% white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B12 deficiency. RESULTS - : The mean tHcy was 9.4±4.8 μmol/L (median=8.6). The prevalence of carotid plaque was 57% (52% among Hispanics, 58% black, and 70% white). Among those with plaque, the mean TPA was 20.3±20.6 mm (median=13.6) and mean GSM 90.9±28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95% confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95% CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95% CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95% CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95% CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95% CI, 1.3-3.7]). CONCLUSIONS - : In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.

Original languageEnglish
Pages (from-to)457-461
Number of pages5
JournalStroke
Volume44
Issue number2
DOIs
StatePublished - Feb 1 2013

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Densitometry
Homocysteine
Odds Ratio
Confidence Intervals
Hispanic Americans
Logistic Models
Stroke
Atherosclerotic Plaques
Population
Renal Insufficiency

Keywords

  • atherosclerosis
  • carotid arteries
  • echodense plaque
  • echolucent plaque
  • gray-scale median
  • homocysteine
  • plaque area
  • ultrasonography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Elevated homocysteine and carotid plaque area and densitometry in the northern Manhattan study. / Alsulaimani, Sara; Gardener, Hannah; Elkind, Mitchell S V; Cheung, Ken; Sacco, Ralph L; Rundek, Tatjana.

In: Stroke, Vol. 44, No. 2, 01.02.2013, p. 457-461.

Research output: Contribution to journalArticle

Alsulaimani, Sara ; Gardener, Hannah ; Elkind, Mitchell S V ; Cheung, Ken ; Sacco, Ralph L ; Rundek, Tatjana. / Elevated homocysteine and carotid plaque area and densitometry in the northern Manhattan study. In: Stroke. 2013 ; Vol. 44, No. 2. pp. 457-461.
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abstract = "BACKGROUND AND PURPOSE - : Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort. METHODS - : In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66±9; 41{\%} men; 19{\%} black; 62{\%} Hispanic; 17{\%} white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B12 deficiency. RESULTS - : The mean tHcy was 9.4±4.8 μmol/L (median=8.6). The prevalence of carotid plaque was 57{\%} (52{\%} among Hispanics, 58{\%} black, and 70{\%} white). Among those with plaque, the mean TPA was 20.3±20.6 mm (median=13.6) and mean GSM 90.9±28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95{\%} confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95{\%} CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95{\%} CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95{\%} CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95{\%} CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95{\%} CI, 1.3-3.7]). CONCLUSIONS - : In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.",
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AU - Alsulaimani, Sara

AU - Gardener, Hannah

AU - Elkind, Mitchell S V

AU - Cheung, Ken

AU - Sacco, Ralph L

AU - Rundek, Tatjana

PY - 2013/2/1

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N2 - BACKGROUND AND PURPOSE - : Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort. METHODS - : In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66±9; 41% men; 19% black; 62% Hispanic; 17% white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B12 deficiency. RESULTS - : The mean tHcy was 9.4±4.8 μmol/L (median=8.6). The prevalence of carotid plaque was 57% (52% among Hispanics, 58% black, and 70% white). Among those with plaque, the mean TPA was 20.3±20.6 mm (median=13.6) and mean GSM 90.9±28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95% confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95% CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95% CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95% CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95% CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95% CI, 1.3-3.7]). CONCLUSIONS - : In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.

AB - BACKGROUND AND PURPOSE - : Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort. METHODS - : In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66±9; 41% men; 19% black; 62% Hispanic; 17% white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B12 deficiency. RESULTS - : The mean tHcy was 9.4±4.8 μmol/L (median=8.6). The prevalence of carotid plaque was 57% (52% among Hispanics, 58% black, and 70% white). Among those with plaque, the mean TPA was 20.3±20.6 mm (median=13.6) and mean GSM 90.9±28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95% confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95% CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95% CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95% CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95% CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95% CI, 1.3-3.7]). CONCLUSIONS - : In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.

KW - atherosclerosis

KW - carotid arteries

KW - echodense plaque

KW - echolucent plaque

KW - gray-scale median

KW - homocysteine

KW - plaque area

KW - ultrasonography

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