Research Article| Volume 14, ISSUE 3, P101-106, May 2005

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Neurologists’ Evaluation and Treatment of Hyperhomocysteinemia in Stroke Patients

  • Cheryl D. Bushnell
    Address reprint requests to Cheryl Bushnell, MD, MHS, PO Box 2900, Duke University Medical Center, Durham, NC 27710.
    Department of Medicine (Neurology), Duke University Medical Center, Durham, NC

    Duke Center for Cerebrovascular Disease, Durham, NC

    Center for Clinical Health Policy Research, Durham, NC
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  • Larry B. Goldstein
    Department of Medicine (Neurology), Duke University Medical Center, Durham, NC

    Duke Center for Cerebrovascular Disease, Durham, NC

    Center for Clinical Health Policy Research, Durham, NC

    Durham VA Medical Center, Durham, NC
    Search for articles by this author
      Observational study data have suggested that neurologists preferentially selected younger patients with generally few traditional stroke risk factors for homocysteine testing. The aim of this study was to corroborate observational data by assessing neurologists’ reported practices for the detection and treatment of hyperhomocysteinemia in patients with acute ischemic stroke. All academic neurology faculty (n = 49), trainees (neurology residents/fellows, n = 53), and a random sample of community-based neurologists (n = 66) throughout North Carolina were surveyed regarding their homocysteine testing and treatment practices. Nine neurologists were ineligible because they had either retired or moved out of state. A total of 93 of the remaining 159 surveys (58.5%) were completed (response rates: faculty, 74%; trainees, 47%; community-based neurologists, 56%). Patients age < 50 years (n = 52; 63%) and the absence of traditional stroke risk factors (n = 57; 70%) were the most common factors cited as prompting homocysteine testing. The homocysteine level threshold for treatment varied independently by practice type (faculty: median, 14 μmol/L; range, 6–16 μmol/L; trainees: median, 14.5 μmol/L; range, 10–20 μmol/L; community-based: median, 10.4 μmol/L; range, 7–15 μmol/L; P = .01), the number of stroke patients evaluated during a typical week (Spearman’s r = .32; P = .034), and year of training completion (Spearman’s r = .41; P = .003). About half (51%) treat elevated homocysteine with a combination of folate, vitamin B12, and vitamin B6. Consistent with observational data, the majority of the neurologists surveyed report that they select young stroke patients who lack traditional stroke risk factors for homocysteine testing. Thresholds for treatment varied between community-based and academic neurologists and correlated with the physicians’ stroke patient volume.

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