Segment-specific association between plasma homocysteine level and carotid artery intima-media thickness in the Framingham Offspring Study

Marion Dietrich, Paul F. Jacques, Joseph F. Polak, Michelle J. Keyes, Michael J. Pencina, Jane C. Evans, Philip A. Wolf, Jacob Selhub, Ramachandran S. Vasan, Ralph B. D'Agostino

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Elevated plasma total homocysteine (tHcy) level is an established risk factor for cardiovascular disease. The relationship between tHcy and carotid artery intima-media thickness (IMT) at the internal carotid artery (ICA)/bulb-IMT and common carotid artery (CCA)-IMT had not been systematically studied, however. Because the ICA/bulb segment is more prone to plaque formation than the CCA segment, differential associations with tHcy at these sites might suggest mechanisms of tHcy action. We examined the cross-sectional segment-specific relationships of tHcy to ICA/bulb-IMT and CCA-IMT in 2499 participants from the Framingham Offspring Study who were free of cardiovascular disease. In multivariate linear regression analysis, ICA/bulb-IMT was significantly higher in the fourth tHcy quartile category compared with the other quartile categories, in both the age- and sex-adjusted and the multivariate-adjusted models (P for trend <.0001 and <.01, respectively). We observed a significant age-by-tHcy interaction for ICA/bulb-IMT (P = .03) and thus stratified the analyses by median age (58 years). A significant positive trend between tHcy and ICA/bulb-IMT was seen in individuals age ≥58 years (P for trend <.01), but not in younger individuals (P for trend = .24) in multivariate-adjusted models. For CCA-IMT, no significant trends were observed in any of the analyses. The segment-specific association between elevated tHcy level and ICA/bulb-IMT suggests an association between tHcy and plaque formation.

Original languageEnglish (US)
Pages (from-to)155-161
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number2
StatePublished - Mar 2011
Externally publishedYes


  • Atherosclerosis
  • bifurcation segment (bulb)
  • plaque formation
  • ultrasonography

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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