Homocysteine levels and lacunar brain infarcts in elderly women:: The prospective population study of women in gothenburg

OBJECTIVES: To examine whether total serum homocysteine (tHcy) in a population-based sample of middle-aged women is an independent risk factor for presence of lacunar infarcts (LIs) 24 years later. DESIGN: Prospective population study, follow-up time 24 years. SETTING: Gothenburg, an urban area in western Sweden. PARTICIPANTS: Five hundred twenty-six women, 89.6% of the original study sample of the Population Study of Women in Gothenburg, aged 46 to 60 at baseline in 1968/69 and re-examined at age 70 to 84. MEASUREMENTS: After 24 years of follow-up, all subjects underwent a psychiatric examination, and 277 computerized tomography (CT) scans of the brain were performed. Two radiologists assessed LIs and white matter lesions (WMLs). Baseline serum tHcy was analyzed from frozen stored serum samples. Logistic regression analyses were performed controlling for potential confounders such as age and selected cardiovascular risk factors. RESULTS: Thirty-four subjects had LIs in 1992 (12.3%). In the full multivariate-adjusted stepwise model, LIs were associated with elevated tHcy (odds ratio (OR)=1.09, 95% confidence interval (CI)=1.01-1.17 per mu mol/L of tHcy increment). Women with tHcy values in the highest tertile were almost three times as likely to have LIs (OR=2.82, 95% CI=1.34-5.93) as were those in the lowest tertile. tHcy was not related to WMLs. Subjects who did not undergo a CT scan did not differ from those who did regarding tHcy or any of the covariates studied. CONCLUSION: tHcy in middle-aged women is an independent risk factor for LIs, but not WMLs, as observed using CT later in life.