Objective:

To evaluate the role of endothelial dysfunction biomarkers- homocysteine, thrombomodulin and endothelin-1 in acute ischemic stroke patients, assessing their relationship with stroke.

Background:

Stroke remains the second leading cause of death and long-term disability worldwide, with cardiovascular diseases accounting for over 60% of all deaths in Uzbekistan. Despite advances in clinical management, early diagnostic and prognostic tools remain limited. Endothelial dysfunction is a key mechanism in ischemic stroke pathogenesis, yet biomarkers such as homocysteine, thrombomodulin, and endothelin-1 are underexplored in local populations.

Design/Methods:

A cross-sectional study was conducted on 180 participants (135 AIS, 29 with chronic cerebrovascular insufficiency [CCI], and 16 healthy controls) aged 44-90 years. Plasma levels of homocysteine, thrombomodulin, and endothelin-1 were measured using ELISA within 16 hours of stroke onset.

Results:

Biomarker levels were significantly elevated in AIS patients compared to CCI and healthy controls (p<0.001). Thrombomodulin increased from 21.25 µg/L (controls) and 25.6 µg/L (CCI) to 94.0 µg/L (AIS) a 4.4-fold rise. Endothelin-1 rose from 2.85 pg/mL and 4.92 pg/mL to 9.7 pg/mL, showing a 3.4-fold increase. Homocysteine rose from 4.25 µmol/L and 5.84 µmol/L to 19.9 µmol/L, a 4.7-fold elevation. Levels were highest in elderly AIS patients (TM = 131.75 µg/L, ET-1 = 10.8 pg/mL, Hcy = 20.6 µmol/L). Males had higher thrombomodulin and homocysteine, while females showed higher endothelin-1 values.

Conclusions:

Elevated endothelial dysfunction biomarkers are closely associated with the presence and severity of acute ischemic stroke. Thrombomodulin demonstrated the most pronounced rise, highlighting its potential as a key indicator of endothelial injury. These biomarkers may serve as useful adjuncts for early diagnosis and personalized management in stroke care.