Elevated plasma homocysteine: cause or consequence of myocardial infarction?

Area of Science:

• Cardiovascular Disease Epidemiology
• Biomarkers of Cardiac Events
• Metabolic Syndrome Research

Background:

• Elevated plasma homocysteine levels are a potential risk factor for cardiovascular diseases, including myocardial infarction.
• Previous research suggests a link between homocysteine and myocardial infarction, but the temporal relationship and confounding factors require further investigation.

Purpose of the Study:

• To investigate if a first myocardial infarction (MI) leads to increased plasma homocysteine concentrations.
• To determine if the association between homocysteine and MI is stronger at follow-up compared to baseline measurements.

Main Methods:

• A population-based, prospective, nested case-referent study design was employed.
• Participants (n=78) who developed a first MI were compared with matched referents (n=56) from a larger screened population (over 36,000).
• Plasma homocysteine levels were compared at baseline and follow-up (average 8.5 years between surveys).

Main Results:

• No statistically significant difference in plasma homocysteine was observed between cases and referents at baseline or follow-up.
• Plasma homocysteine and creatinine levels increased significantly over time, while albumin decreased.
• High homocysteine at follow-up showed a univariate association with MI (OR 2.49), but this was not significant in multivariate analyses. High plasma creatinine, however, remained significantly associated with MI at both time points.

Conclusions:

• This study found no evidence that a first myocardial infarction causes increased plasma homocysteine concentrations.
• Plasma creatinine, not homocysteine, emerged as a significant predictor of myocardial infarction in this cohort.