Objectives: We compared various forms of plasma homocysteine (Hcy) including total Hcy (tHcy), free reduced Hcy (reHcy), free oxidized Hcy (oxHcy) and reHcy plus oxHcy between patients with acute/subacute-ischemic stroke and healthy controls. We also investigated whether the patients have increased oxidative stress.
Design and methods: Using an in-tube derivatization method, we measured plasma levels of tHcy, reHcy and oxHcy in 55 ischemic-stroke patients (14 females and 41 males, median age 64) and 52 age-matched healthy subjects (15 females and 37 males, median age 60). We also measured plasma malondialdehyde (MDA, as lipid peroxidation marker) and oxygen-radical absorbance capacity (ORAC, as total antioxidant activity).
Results: The plasma levels of reHcy and reHcy plus oxHcy and the ratio of reHcy to oxHcy were significantly higher in the patients than in the age-matched controls, whereas tHcy and oxHcy levels were not significantly different. The patients had a significantly higher level of MDA but a lower value of ORAC than that of controls. A significantly positive correlation was found in the levels of reHcy vs. MDA (r = 0.19, P < 0.03), whereas significant negative correlations were found for reHcy vs. ORAC (r = -0.30, P < 0.001) and free Hcy vs. ORAC (r = -0.30, P < 0.001).
Conclusions: reHcy and reHcy plus oxHcy Hcy, rather than tHcy, are significantly elevated in patients with acute/subacute ischemic stroke. The elevated reHcy along with elevated MDA level and lowered ORAC value in the plasma of the stroke patients indicates an imbalance of antioxidant-prooxidant status in acute ischemic stroke.