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Prospective study of hyperhomocysteinemia as an adverse cardiovascular risk factor in end-stage renal disease

A Moustapha1, A Naso, M Nahlawi

  • 1Department of Internal Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.

Circulation
|January 28, 1998
PubMed

Insights

Elevated homocysteine levels significantly increase cardiovascular risk in end-stage renal disease patients. This prospective study confirms hyperhomocysteinemia as an independent predictor of cardiovascular events and mortality.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Biochemistry

Background:

  • Hyperhomocysteinemia is a known risk factor for atherosclerosis in end-stage renal disease (ESRD) patients.
  • Previous studies suggest an association, but prospective data are limited.

Purpose of the Study:

  • To prospectively investigate the association between total homocysteine levels and cardiovascular outcomes in ESRD patients.
  • To identify independent predictors of cardiovascular morbidity and mortality in this population.

Main Methods:

  • Prospective cohort study of 167 ESRD patients (mean age 56.3 years).
  • Follow-up duration averaged 17.4 months.
  • Cox regression analysis used to determine independent predictors of cardiovascular events and mortality.

Main Results:

  • 55 patients (33%) experienced cardiovascular events; 31 (19%) died, 12 from cardiovascular causes.
  • Higher total homocysteine levels were observed in patients with cardiovascular events or cardiovascular mortality (43.0±48.6 vs. 26.9±14.9 μmol/L, P=.02).
  • A 1% increase in relative risk for cardiovascular events per 1 μmol/L increase in total homocysteine (RR 1.01; 95% CI 1.00-1.01; P=.01).

Conclusions:

  • Hyperhomocysteinemia is confirmed as an independent risk factor for cardiovascular morbidity and mortality in ESRD.
  • A 1% increased relative risk for cardiovascular events is associated with each 1 μmol/L rise in total homocysteine.
  • Further interventional studies are warranted to assess the impact of modifying homocysteine levels in ESRD patients.
Abstract

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