Tareq Kasshout, MD

Alsulaimani S, Gardener H, Elkind MSV, Cheung K, Sacco RL, Rundek T. Elevated Homocysteine and Carotid Plaque Area and Densitometry in the Northern Manhattan Study. Stroke. 2013; 44: 457-461.

In a study recently published online in Stroke,Alsulaimani and colleagues are proposing an association between elevated homocysteine levels and carotid artery plaque morphology in patients who are at increased risk for stroke. Elevated homocysteine levels, in its relationship to atherosclerosis, and plaque area and morphology, which correspond to the “vulnerable” plaque histology, are subclinical markers of stroke risk.
This sub-study from the Northern Manhattan Study (NOMAS) showed that an elevated level of homocysteine is an independent risk factor for greater plaque burden. Moreover, it was associated with both echo-lucent (low-density plaques with low content of calcification) and echo-dense (high density plaques with high content of calcification). Both types of plaques, as a marker of generalized atherosclerosis, have been associated with increased risk of stroke.
The existing and consistent evidence of homocysteine as a risk factor for carotid atherosclerosis, has now been associated with two novel imaging biomarkers of atherosclerosis (carotid plaque morphology and total carotid plaque area). However, the effect of lowering homocysteine on atherosclerotic lesions in primary prevention is still unknown.