The Correlation between Homocysteine Levels and the Incidence of Ischemic Stroke and the Role of Dietary Supplements

Abstract

Background and objectives: Cerebrovascular accident, commonly referred to as stroke, represents a predominant cause of mortality and morbidity globally, thereby imposing a substantial strain on both healthcare infrastructures and individual patients. High levels of homocysteine ​​(Hcy) are considered a risk factor for stroke and its various subtypes. The present study aimed to investigate the association between serum homocysteine ​​concentration and the occurrence of ischemic stroke, as well as the possible effect of dietary supplements.

Methods: The study is a cross-sectional study carried out in Rizgary teaching hospital between October 2024 and June 2025 in the Erbil city, Kurdistan Region-Iraq. A sample population of 100 adults aged 35 years and above, diagnosed with acute ischemic stroke, which was confirmed using radiological imaging, was sampled. Stratification of the participants was done in two groups which consisted of normal Hcy level of the serum (NHLG <15mol/L) and high homocysteine (HHLG ≥15 µmol/L) level. The data were recorded through a questionnaire developed by a researcher and through the medical record abstraction, which included demographic, clinical, lifestyle, and diet variables. Enzyme immunoassay was conducted on serum Hcy levels within 24-48 hours after the onset of the stroke. Independent t-, chi-square or Fisher, exact tests were used to carry out statistical comparisons and a p-value of ≤0.05 was considered statistically significant.

Results: The mean Hcy levels had a statistically significant difference between the NHLG (10.33 ± 2.96 µmol/L) and the HHLG (21.04 ± 5.85 µmol/L) (P ≤ 0.001). The male population was significantly overrepresented within the HHLG (72.2% vs. 42.2%) (P ≤ 0.004), while lower educational attainment levels were markedly more prevalent in the NHLG (P ≤ 0.006). There was no significant inter-group difference on hypertension, body mass index, smoking status, diabetes mellitus or severity of stroke using the National Institutes of Health Stroke Scale (NIHSS). Similarly, there was no significant difference between the participants' intaking dietary supplements. However, there was a low and statistically significant negative relationship between history of stroke and previous supplement intake. (r = –0.201, P = 0.045). In contrast, Hcy levels measured during the acute phase of stroke were not significantly correlated with previous stroke history (r = 0.072, P = 0.477).

Conclusion: The level of serum Hcy in patients with an ischemic stroke was significantly correlated with demographic factors including sex and education level, but no statistically significant relationship was established between the levels of Hcy and known risk factors of a stroke as well as the severity of the disease. Moreover, in spite of the fact that vitamin supplementation had a weak inverse correlation with the presence of a previous stroke, its impact on the levels of Hcy was not obvious at the acute stroke stage.