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Serum total homocysteine and coronary heart disease: prospective study in middle aged men
P H Whincup1, H Refsum, I J Perry
1Cardiovascular Research Unit, Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London NW3 2PF, UK. peterw@rfhsm.ac.uk
Insights
Elevated total homocysteine levels are prospectively linked to a higher risk of coronary heart disease events. This finding supports further research into folate interventions for reducing homocysteine.
Area of Science:
- Cardiovascular Epidemiology
- Clinical Biochemistry
- Nutritional Science
Background:
- Elevated serum total homocysteine is a potential risk factor for cardiovascular disease.
- Understanding the prospective relationship between homocysteine and coronary events is crucial for public health.
Purpose of the Study:
- To investigate the prospective association between serum total homocysteine concentrations and major coronary heart disease events.
- To explore the link between homocysteine levels and geographical variations in coronary risk.
Main Methods:
- A nested case-control study within the British Regional Heart Study.
- Analysis of serum total homocysteine in 386 myocardial infarction cases and 454 controls.
- Prospective follow-up over 12.8 years with frequency-matched controls.
Main Results:
- Higher geometric mean serum total homocysteine in cases (14.2 µmol/l) versus controls (13.5 µmol/l).
- A 1 SD increase in log total homocysteine associated with a 1.15 odds ratio for myocardial infarction (p=0.05).
- Concentrations >16.5 µmol/l accounted for 13% of attributable myocardial infarction risk.
Conclusions:
- Serum total homocysteine shows a prospective relationship with increased coronary heart disease risk.
- Homocysteine levels may correlate with geographical differences in coronary risk within Britain.
- Results support clinical trials investigating homocysteine reduction using folate.
Objectives:
To examine the prospective relation between total homocysteine and major coronary heart disease events.
Design:
A nested case-control study carried out within the British regional heart study, a prospective investigation of cardiovascular disease in men aged 40-59 years at entry. Serum total homocysteine concentrations were analysed retrospectively and blindly in baseline samples from 386 cases who had a myocardial infarct during 12.8 years of follow up and from 454 controls, frequency matched by age and town.
Results:
Geometric mean serum total homocysteine was slightly higher in cases (14.2 micromol/l) than in controls (13.5 micromol/l), a proportional difference of 5.5% (95% confidence interval (CI) -0.02% to 10.8%, p = 0.06). Age adjusted risk of myocardial infarction increased weakly with log total homocysteine concentration; a 1 SD increase in log total homocysteine (equivalent to a 47% increase in total homo cysteine) was associated with an increase in odds of myocardial infarction of 1.15 (95% CI 1.00 to 1. 32; p = 0.05). The relation was particularly marked in the top fifth of the total homocysteine distribution (values >16.5 micromol/l), which had an odds ratio of 1.77 (95% CI 1.28 to 2.42) compared with lower levels. Adjustment for other risk factors had little effect on these findings. Total homocysteine concentrations more than 16.5 micromol/l accounted for 13% of the attributable risk of myocardial infarction in this study population. Serum total homocysteine among control subjects varied between towns and was correlated with town standardised mortality ratios for coronary heart disease (r = 0.43, p = 0.08).
Conclusions:
Serum total homocysteine is prospectively related to increased coronary risk and may also be related to geographical variation in coronary risk within Britain. These results strengthen the case for trials of total homocysteine reduction with folate.