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Homocysteine and coronary heart disease risk in the PRIME study
J A Troughton1, J V Woodside, I S Young
1Faculty of Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.
Insights
Elevated homocysteine is linked to coronary heart disease (CHD) risk, particularly in current smokers. This study found a significant interaction between homocysteine, smoking, and CHD risk.
Area of Science:
- Cardiovascular Epidemiology
- Clinical Biochemistry
Background:
- Recent meta-analyses suggest homocysteine as an independent predictor of coronary heart disease (CHD).
- Debate exists on whether homocysteine's deleterious effects are synergistic with other risk factors.
- The Prospective Epidemiological Study of Myocardial Infarction (PRIME) investigated cardiovascular risk factors in men from France and Northern Ireland.
Purpose of the Study:
- To determine if higher homocysteine levels are associated with increased CHD risk in the PRIME case-control cohort.
- To investigate potential synergistic interactions between homocysteine and pre-existing CHD risk factors.
Main Methods:
- Homocysteine levels were measured in 323 participants who developed CHD and 638 matched controls.
- Data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) were analyzed.
- Statistical analysis included case-control comparisons and interaction testing.
Main Results:
- No significant difference in homocysteine levels was observed between CHD cases and controls (p=0.18).
- Homocysteine levels were significantly higher in current smokers compared to non-smokers (p=0.007).
- A significant interaction was found between homocysteine, smoking, and CHD risk (chi2=10.29, p=0.006).
Conclusions:
- Elevated homocysteine is significantly associated with coronary heart disease risk specifically in current smokers.
- The findings highlight the importance of considering smoking status when evaluating homocysteine's role in CHD risk.
Introduction:
Despite recent meta-analyses suggesting that homocysteine is an independent predictor of coronary heart disease (CHD), there is debate regarding whether elevated homocysteine may be deleterious only in the presence of other risk factors, with which it acts synergistically to exert a multiplicative effect on CHD risk, emerging only as a CHD predictor in patients with pre-existing risk factors. The Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study is a multicentre prospective study of 10593 men from France and Northern Ireland, investigating cardiovascular risk factors. We investigated: (1) whether higher homocysteine is associated with increased CHD risk in the PRIME case-control cohort; (2) whether homocysteine interacts synergistically with pre-existing CHD risk factors.
Methods:
Homocysteine was measured in 323 participants who had developed CHD at 5-year follow-up and in 638 matched controls.
Results:
There was no significant difference in homocysteine between cases and controls (p=0.18). Homocysteine was significantly higher in current smokers (geometric mean mumol/l (interquartile range mumol/l) 9.45 (7.43, 11.75)) compared with non-smokers (8.90 (7.32, 10.70); p=0.007). There was a significant interaction between homocysteine, smoking and CHD risk (chi2=10.29, d.f.=2, p=0.006).
Conclusions:
These findings suggest that elevated homocysteine is significantly associated with CHD risk in current smokers.
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