Serum Homocysteine Levels and All-Cause and Cause-Specific Mortality in Korean Adult Men: A Cohort Study
Minyoung Kim1, Sujeong Shin1, Eunsol Yoo1
1Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea.
Insights
Both low and high homocysteine levels increase mortality risk in Korean men, revealing a U-shaped association. Vitamin supplementation may mitigate this cardiovascular disease and all-cause mortality risk.
Area of Science:
- Biomedical research
- Epidemiology
- Clinical biochemistry
Background:
- Hyperhomocysteinemia is a known risk factor for cardiovascular disease (CVD), cancer, and neurological disorders.
- Hypohomocysteinemia (low homocysteine) has not been extensively studied for potential health risks.
- Understanding the full spectrum of homocysteine levels and mortality risk is crucial for public health.
Purpose of the Study:
- To investigate the association between all homocysteine levels (low and high) and mortality risk in adult Korean men.
- To determine the specific mortality risks associated with different homocysteine concentrations.
- To explore potential modifying effects of vitamin supplementation on the homocysteine-mortality relationship.
Main Methods:
- A large cohort study of 221,356 adult Korean men was analyzed.
- Participants were categorized into quintiles based on homocysteine levels.
- Cox proportional hazards and restricted cubic spline models were used to assess all-cause, CVD, cancer, and dementia mortality risks.
Main Results:
- Both low and high homocysteine levels were significantly associated with increased all-cause mortality compared to the reference range (8.8-9.9 µmol/L).
- A U-shaped relationship was observed between homocysteine levels and all-cause and CVD mortality, with an inflection point at 9.1 µmol/L.
- This U-shaped association was not significant in the subgroup of men taking vitamin supplements.
Conclusions:
- Both low and high homocysteine levels pose an increased risk for all-cause and CVD mortality in adult Korean men.
- The observed U-shaped relationship suggests that maintaining homocysteine within a specific optimal range is important.
- Vitamin supplementation may play a protective role, potentially attenuating the mortality risks associated with abnormal homocysteine levels.
Background:
Hyperhomocysteinemia can increase the risk of cardiovascular disease (CVD), cancer, and neurological disorders; however, hypohomocysteinemia is generally not considered harmful. This study aimed to evaluate the relationship between all levels of homocysteine, both low and high homocysteine levels, and the risk of all-cause and cause-specific mortality in adult Korean men.
Methods:
Adult Korean men (n = 221,356) were categorized into quintiles based on their homocysteine levels. The primary endpoints were all-cause, CVD, cancer, and dementia mortality. Hazard ratios were calculated using Cox proportional hazards models, and the dose-response relationship between homocysteine levels and mortality risk was further explored using restricted cubic spline models.
Results:
Compared with the reference category (Q2, 8.8-9.9 µmol/L), there was a significant increase in all-cause mortality associated with both low and high levels after multivariable adjustment (Pinteraction = 0.002). Additionally, in spline regression, a U-shaped association between homocysteine levels and all-cause and CVD mortality was observed (inflection point = 9.1 µmol/L). This association was not observed in the vitamin supplementation subgroup.
Conclusion:
Among Korean adult men, both low and high homocysteine levels increased the risk of all-cause and CVD mortality, indicating a U-shaped relationship. However, this relationship was not statistically significant with vitamin supplementation, suggesting a potential protective role for vitamins.
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