title: Hyperhomocystinemia: a risk factor or a consequence of coronary heart disease?
abstract: 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.
authors: National Public Health, Mannerheimintie 166, 00300 Helsinki, Finland. paul.knekt@ktl.fi
authors: P
authors: P
authors: Knekt
authors: A
authors: A
authors: Reunanen
authors: G
authors: G
authors: Alfthan
authors: M
authors: M
authors: Heliövaara
authors: H
authors: H
authors: Rissanen
authors: J
authors: J
authors: Marniemi
authors: A
authors: A
authors: Aromaa
mesh_terms: 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
chemical_list: D006710:Homocysteine; D002784:Cholesterol