Association between total homocyst(e)ine and the likelihood for a history of acute myocardial infarction by race and ethnicity: Results from the Third National Health and Nutrition Examination Survey.
BACKGROUND
Few studies examining the association between total homocyst(e)ine and coronary heart disease have included blacks or Hispanics.


METHODS
Data from the third National Health and Nutrition Examination Survey (3173 patients), a nationally representative survey of US adults, were used to examine the relation between total homocyst(e)ine and an electrocardiogram or a physician's diagnosis of acute myocardial infarction (259 patients) among whites, blacks, and Mexican Americans >/=40 years old.


RESULTS
Vitamin B(12) and serum folate concentrations were significantly lower among persons with a total homocyst(e)ine concentration >/=15 micromol/L than among those with a total homocyst(e)ine concentration </=10 micromol/L. Persons with a total homocyst(e)ine concentration >/=15 micromol/L were also older and more likely to be hypertensive, have a higher cholesterol concentration, and smoke. Compared with persons with a total homocyst(e)ine concentration </=10 micromol/L, persons with a concentration >/=15 micromol/L had an odds ratio (OR) for myocardial infarction of 1.8 (95% confidence interval [CI], 1.2-2.9) after adjustment for cardiovascular disease risk factors. Similar associations were noted among whites (OR 1.8, 95% CI, 1.1-3.1) and blacks (OR 1.9, 95% CI, 0.8-4.2); a more modest association was noted among Mexican Americans (OR 1.2, 95% CI, 0.3-5.0). The association between total homocyst(e)ine and myocardial infarction was also more pronounced in persons without hypertension or diabetes.


CONCLUSIONS
Almost a 2-fold increased likelihood of myocardial infarction among persons with a total homocyst(e)ine concentration >/=15 micromol/L was noted in this nationally representative survey. The magnitude of the association did not differ by race or ethnicity.
Giles
W H
WH
Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. hwg0@cdc.gov
Croft
J B
JB
Greenlund
K J
KJ
Ford
E S
ES
Kittner
S J
SJ
D017677:Age Distribution; D044383:Black People; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005492:Folic Acid; D006710:Homocysteine / Q000097:blood*; D006711:Homocystine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000208:ethnology*; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014805:Vitamin B 12 / Q000097:blood; D044465:White People; D001741:Black or African American
D006710:Homocysteine; D006711:Homocystine; D005492:Folic Acid; D002784:Cholesterol; D014805:Vitamin B 12