Elevated homocysteine level and prognosis in patients with acute coronary syndrome: a meta-analysis
Mingjin Zhu1, Meng Mao2, Xusheng Lou3
1a Department of Geratology , Beijing University of Chinese Medicine Third Affiliated Hospital , Beijing , China.
Insights
Elevated homocysteine levels in acute coronary syndrome (ACS) patients are linked to a higher risk of major adverse cardiovascular events (MACE) and all-cause mortality. Further research is needed to confirm the association with cardiovascular mortality.
Area of Science:
- Cardiology
- Clinical Biochemistry
Background:
- Conflicting data exists regarding the prognostic significance of elevated homocysteine in acute coronary syndrome (ACS).
- Homocysteine, an amino acid, is implicated in cardiovascular disease pathogenesis.
Purpose of the Study:
- To conduct a meta-analysis evaluating the prognostic value of homocysteine levels in ACS patients.
- To assess the association between homocysteine and major adverse cardiovascular events (MACE) and mortality in ACS.
Main Methods:
- A systematic literature search of PubMed and Embase databases was performed.
- Included prospective observational studies reporting baseline homocysteine levels and clinical outcomes in ACS patients.
- Pooled risk ratios (RR) were calculated comparing highest versus lowest homocysteine levels.
Main Results:
- Ten studies with 4120 ACS patients were analyzed.
- High homocysteine levels significantly increased the risk of MACE (RR 2.01) and all-cause mortality (RR 2.05).
- No significant association was found between elevated homocysteine and cardiovascular mortality (RR 1.08).
Conclusions:
- Elevated homocysteine is associated with increased MACE and all-cause mortality in ACS patients.
- The link between high homocysteine and cardiovascular mortality in ACS requires further investigation.
Abstract:
Objective: Controversial results exist with respect to the association between elevated homocysteine level and adverse prognosis in acute coronary syndrome (ACS) patients. We performed a meta-analysis to evaluate the prognostic value of homocysteine level on ACS patients. Materials and methods: A comprehensive literature search of PubMed and Embase databases was conducted prior to August 2018. Prospective observational studies reporting the association of baseline homocysteine level with major adverse cardiovascular events (MACE), cardiovascular or all-cause mortality in ACS patients were selected. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CI) were calculated for the highest versus the lowest homocysteine level. Results: Ten studies including 4120 ACS patients were identified. ACS patients with the highest homocysteine level had an increased risk of MACE (RR 2.01; 95% CI 1.53-2.64) and all-cause mortality (RR 2.05; 95% CI 1.50-2.79) after controlling confounding factors. However, the association between elevated homocysteine level and cardiovascular mortality (RR 1.08; 95% CI 0.83-1.39) was not statistically significant. Conclusions: Elevated homocysteine level was associated with an increased risk of MACE and all-cause mortality among ACS patients. However, the association of elevated homocysteine level with cardiovascular mortality in ACS patients should be further confirmed in future studies.
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