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Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study
M L Bots1, L J Launer, J Lindemans
1Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Insights
Elevated plasma total homocysteine (tHcy) is linked to increased atherosclerosis and cardiovascular disease risk in older adults aged 55-74. This association was not observed in those 75 and older, likely due to selective mortality.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Biochemistry
Background:
- Elevated plasma total homocysteine (tHcy) is a known risk factor for vascular disease, particularly in younger individuals.
- Research on the association between tHcy and vascular disease in older populations is limited.
Purpose of the Study:
- To investigate the relationship between plasma tHcy levels and atherosclerosis in older men and women.
- To assess the association of tHcy with symptomatic cardiovascular disease in an elderly cohort.
Main Methods:
- A cross-sectional study involving a general population sample.
- 630 men and women aged 55 years and over from the Rotterdam Study cohort.
- Carotid atherosclerosis assessed via ultrasonography; peripheral artery disease by ankle-arm index; cardiovascular disease by history of myocardial infarction or stroke.
Main Results:
- In subjects aged 55-74, elevated tHcy was associated with thicker common carotid intima-media (0.037 mm difference) and a lower ankle-arm index (-0.054).
- Elevated tHcy correlated with a 3-fold increased risk of cardiovascular disease in the 55-74 age group.
- No significant association between tHcy and atherosclerosis or cardiovascular disease was found in subjects aged 75 and older.
Conclusions:
- Elevated plasma tHcy is associated with increased atherosclerosis and cardiovascular disease risk in individuals aged 55-74.
- The absence of this association in individuals aged 75 and older likely results from selective mortality, where those with higher tHcy levels may not survive to this age.
Objectives:
Elevated homocysteine increases the risk of vascular disease, in particular amongst younger subjects (< 60 years). Very few studies have been performed amongst older subjects. We evaluated the relation of plasma total homocysteine (tHcy) to atherosclerosis and symptomatic cardiovascular disease amongst older men and women.
Design:
A cross-sectional study.
Setting:
General population.
Subjects:
A random sample of 630 men and women, participating in the Rotterdam Study, a prospective population-based cohort study amongst 7983 subjects aged 55 years and over residing in the Ommoord district of Rotterdam, the Netherlands.
Main Outcome Measures:
Carotid atherosclerosis (carotid plaques and common carotid intima-media thickness) assessed by ultrasonography; lower extremity (peripheral) artery atherosclerosis measured by the ratio of the ankle to arm systolic blood pressure; prevalent cardiovascular disease assessed as a history of myocardial infarction or stroke.
Results:
Subjects, 55-74 years of age, with elevated tHcy levels (+/- 18.6 mumol L-1) had a thicker common carotid intima-media (difference 0.037 mm; 95% CI 0.001, 0.073), a lower ankle-arm index (-0.054; -0.104, -0.004), and an increased risk of cardiovascular disease (odds ratio 3.0; 1.5, 6.1), after adjusting for sex and age. There was no appreciable association of tHcy levels to atherosclerosis and cardiovascular disease in subjects aged 75 years and older.
Conclusions:
In subjects aged 55-74 years elevated tHcy is associated with an increased risk of atherosclerosis and cardiovascular disease. The lack of association in those aged > or = 75 years most probably reflect selective mortality.