Hyperhomocystinemia: a risk factor or a consequence of coronary heart disease?
BACKGROUND
Mild hyperhomocystinemia has been suggested as an indicator of an increased risk of cardiovascular disease.


OBJECTIVE
To examine whether serum homocysteine concentration is a predictor of coronary heart disease (CHD) events.


METHODS
A case-control study, nested in a population-based cohort study was used. During a follow-up of 13 years, 166 major coronary events (death from CHD or nonfatal myocardial infarction) occurred in men with evidence of heart disease at baseline and 272 events in men without a history of heart disease. Two controls per case were selected by individual matching.


RESULTS
Among men with known heart disease at baseline, the relative risk (95% confidence interval) of CHD events adjusted for age, smoking, hypertension, diabetes mellitus, serum cholesterol level, body mass index, and alcohol consumption was 2.23 (95% confidence interval, 1.03-4.85) in the highest serum homocysteine quintile compared with the lowest quintile. Among the men free of heart disease at baseline, the corresponding relative risk was 0.90 (95% confidence interval, 0.51-1.60).


CONCLUSIONS
This prospective study does not support the hypothesis that a high concentration of serum homocysteine is a risk factor for coronary events in a population free of heart disease. However, it does suggest that mild hyperhomocystinemia predicts secondary coronary events in men with heart disease, possibly as a consequence of atherosclerotic changes.
Knekt
P
P
National Public Health, Mannerheimintie 166, 00300 Helsinki, Finland. paul.knekt@ktl.fi
Reunanen
A
A
Alfthan
G
G
Heliövaara
M
M
Rissanen
H
H
Marniemi
J
J
Aromaa
A
A
D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000209:etiology*; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
D006710:Homocysteine; D002784:Cholesterol