Plasma Total Homocysteine Level Is Related to Unfavorable Outcomes in Ischemic Stroke With Atrial Fibrillation

Ki Woong Nam, Chi Kyung Kim, Sungwook Yu, Kyungmi Oh, Jong Won Chung, Oh Young Bang, Gyeong Moon Kim, Jin Man Jung, Tae Jin Song, Yong Jae Kim, Bum Joon Kim, Sung Hyuk Heo, Kwang Yeol Park, Jeong Min Kim, Jong Ho Park, Jay Chol Choi, Man Seok Park, Joon Tae Kim, Kang Ho Choi, Yang Ha HwangWoo Keun Seo

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4 Scopus citations


BACKGROUND: Unlike patients with stroke caused by other mechanisms, the effect of elevated plasma total homocysteine (tHcy) on the prognosis of patients with both ischemic stroke and atrial fibrillation (AF) is unknown. This study aimed to evaluate the association between tHcy level and the functional outcome of patients with AF-related stroke. METHODS AND RESULTS: We included consecutive patients with AF-related stroke between 2013 and 2015 from the registry of a real-world prospective cohort from 11 large centers in South Korea. A 3-month modified Rankin Scale score ≥3 was considered an unfavorable outcome. Since tHcy is strongly affected by renal function, we performed a subgroup analysis according to the presence of renal dysfunction. A total of 910 patients with AF-related stroke were evaluated (mean age, 73 years; male sex, 56.0%). The mean tHcy level was 11.98±8.81 μmol/L. In multivariable analysis, the tHcy level (adjusted odds ratio, 1.04; 95% CI, 1.01–1.07, per 1 μmol/L) remained significantly associated with unfavorable outcomes. In the subgroup analysis based on renal function, tHcy values above the cutoff point (≥14.60 μmol/L) showed a close association with the unfavorable outcome only in the normal renal function group (adjusted odds ratio, 3.10; 95% CI, 1.60– 6.01). In patients with renal dysfunc-tion, tHcy was not significantly associated with the prognosis of AF-related stroke. CONCLUSIONS: A higher plasma tHcy level was associated with unfavorable outcomes in patients with AF-related stroke. This positive association may vary according to renal function but needs to be verified in further studies.

Original languageEnglish
Article numbere022138
JournalJournal of the American Heart Association
Issue number9
StatePublished - 3 May 2022

Bibliographical note

Funding Information:
This study was partially supported by Korea University Grant (K1824521) and the National Research Foundation of Korea (NRF-2019R1A2C2008788).

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • atrial fibrillation
  • homocysteine
  • ischemic stroke
  • prognosis
  • vitamin


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