title: Plasma homocysteine concentration predicts mortality in non-insulin-dependent diabetic patients with and without albuminuria.
abstract: BACKGROUND
  A high plasma total homocysteine (tHcy) concentration is a risk factor for cardiovascular disease in the nondiabetic population and in nondiabetic patients with end-stage renal disease.
  
  
  METHODS
  We prospectively evaluated the impact of tHcy concentrations on mortality in 211 white non-insulin-dependent diabetic (NIDDM) patients of less than 70 years of age at entry (61 with microalbuminuria and 44 with macroalbuminuria). They were followed for a median of 6.4 (range 0.2 to 7.1) years.
  
  
  RESULTS
  At the end of the follow-up period, 49 of 211 (23%) patients had died, 30 (61%) from cardiovascular disease. Univariate Cox survival analysis revealed that baseline tHcy level (1 micromol/liter) was associated with an increased all-cause mortality risk of 1.11 [95% confidence interval (CI) 1.08 to 1.15, P < 0.0001], and a cardiovascular mortality risk of 1.09 (CI 1.03 to 1.16, P < 0.01). The six-year cumulative all-cause mortality hazard was 44%, 14%, and 15% in the high (tHcy >/= 8.2 micromol/liter), the middle (tHcy 6. 2-8.1 micromol/liter), and the low (tHcy </= 6.1 micromol/liter) tertile of tHcy levels, respectively (P < 0.001 high vs. middle; P < 0.001 high vs. low; and P = 0.88 middle vs. low). Cox proportional hazards regression analysis revealed significant predictors of all-cause mortality to be tHcy level (per 1 micromol/liter), relative risk 1.09 (1.03 to 1.14); pre-existing coronary heart disease (yes vs. no), relative risk 1.98 (1.09 to 3.61); log10 albumin excretion rate (AER; factor 10), relative risk 1.89 (1.31 to 2.74); and age (per 1 year), relative risk 1.08 (1.03 to 1.13). Predictors of cardiovascular mortality were pre-existing coronary heart disease, log10 AER, and age. tHcy level did not predict cardiovascular mortality independently of these risk factors.
  
  
  CONCLUSIONS
  Plasma tHcy concentration is a significant predictor of mortality in NIDDM patients with or without albuminuria.
authors.affiliation: Department of Internal Medicine, Academisch Ziekenhuis Vrije Universiteit and Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, the Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: M A
authors.initials: MA
authors.lastname: Gall
authors.forename: P
authors.initials: P
authors.lastname: Hougaard
authors.forename: C
authors.initials: C
authors.lastname: Jakobs
authors.forename: H H
authors.initials: HH
authors.lastname: Parving
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood* / Q000150:complications; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000401:mortality*; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D006710:Homocysteine