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Hyperhomocystinemia: a risk factor or a consequence of coronary heart disease?
P Knekt1, A Reunanen, G Alfthan
1National Public Health, Mannerheimintie 166, 00300 Helsinki, Finland. paul.knekt@ktl.fi
Insights
Mild hyperhomocystinemia may predict secondary coronary events in men with existing heart disease. However, high homocysteine levels do not appear to be a risk factor for new coronary events in those without prior heart disease.
Area of Science:
- Cardiovascular Medicine
- Clinical Biochemistry
- Epidemiology
Background:
- Mild hyperhomocystinemia is a potential indicator of increased cardiovascular disease risk.
- The role of serum homocysteine in predicting coronary heart disease (CHD) events requires further investigation.
Purpose of the Study:
- To determine if serum homocysteine concentration predicts coronary heart disease (CHD) events.
- To differentiate the predictive value of homocysteine in primary versus secondary cardiovascular disease prevention.
Main Methods:
- A nested case-control study within a population-based cohort.
- Follow-up of 13 years with 166 major coronary events in men with pre-existing heart disease and 272 in men without.
- Individual matching of two controls per case.
Main Results:
- Among men with known heart disease, the highest homocysteine quintile showed a 2.23-fold increased risk of CHD events (95% CI, 1.03-4.85) compared to the lowest.
- In men without prior heart disease, the relative risk of CHD events associated with the highest homocysteine quintile was 0.90 (95% CI, 0.51-1.60).
Conclusions:
- High serum homocysteine is not supported as a risk factor for primary coronary events in individuals without pre-existing heart disease.
- Mild hyperhomocystinemia may predict secondary coronary events in men with established heart disease, potentially linked to atherosclerotic processes.
Background:
Mild hyperhomocystinemia has been suggested as an indicator of an increased risk of cardiovascular disease.
Objective:
To examine whether serum homocysteine concentration is a predictor of coronary heart disease (CHD) events.
Methods:
A case-control study, nested in a population-based cohort study was used. During a follow-up of 13 years, 166 major coronary events (death from CHD or nonfatal myocardial infarction) occurred in men with evidence of heart disease at baseline and 272 events in men without a history of heart disease. Two controls per case were selected by individual matching.
Results:
Among men with known heart disease at baseline, the relative risk (95% confidence interval) of CHD events adjusted for age, smoking, hypertension, diabetes mellitus, serum cholesterol level, body mass index, and alcohol consumption was 2.23 (95% confidence interval, 1.03-4.85) in the highest serum homocysteine quintile compared with the lowest quintile. Among the men free of heart disease at baseline, the corresponding relative risk was 0.90 (95% confidence interval, 0.51-1.60).
Conclusions:
This prospective study does not support the hypothesis that a high concentration of serum homocysteine is a risk factor for coronary events in a population free of heart disease. However, it does suggest that mild hyperhomocystinemia predicts secondary coronary events in men with heart disease, possibly as a consequence of atherosclerotic changes.