title: Plasma total homocysteine and hospitalizations for cardiovascular disease: the Hordaland Homocysteine Study.
abstract: BACKGROUND
  Elevated total plasma homocysteine (tHcy) level is a risk factor for occlusive disease in the coronary, cerebral, and peripheral vessels and is related to several lifestyle factors associated with cardiovascular disease (CVD).
  
  
  OBJECTIVE
  To examine the association of a single tHcy measurement on subsequent hospitalizations due to CVD.
  
  
  METHODS
  A population-based prospective cohort study was conducted from April 1, 1992, to May 31, 1998 (mean follow-up, 5.3 years) in western Norway. The study included 17 361 individuals aged 40 to 42 or 65 to 67 years at baseline. Main outcome measure was CVD as the main hospital discharge diagnosis or coronary revascularization procedures (denoted "CVD hospitalizations") during follow-up (n = 1275).
  
  
  RESULTS
  At baseline, participants with preexisting CVD had higher mean tHcy values than individuals without CVD. Risk of CVD hospitalizations increased significantly with increasing baseline tHcy only in the oldest age group. Here, multiple risk factor-adjusted hospitalization rate ratios in 5 tHcy categories (<9, 9-11.9, 12-14.9, 15-19.9, and >or=20 micromol/L [to convert tHcy to milligrams per liter, divide by 7.397]) were as follows: 1 (reference level), 1.00, 1.34, 1.67, and 1.94, respectively (P for trend <.001). The relation between tHcy level and CVD hospitalizations was significantly stronger among individuals with preexisting CVD than those without (hospitalization rate ratio per 5-micromol/L tHcy increment, 1.29 vs 1.10; P for interaction,.02).
  
  
  CONCLUSIONS
  Plasma tHcy level is a strong predictor of CVD hospitalizations only in elderly individuals, and especially among those with preexisting CVD. Our findings are compatible with the theory that tHcy interacts with conventional CVD risk factors to provoke the acute event of CVD.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Armauer Hansen's Building, N-5021 Bergen, Norway. eha.nurk@isf.uib.no
authors.forename: Eha
authors.initials: E
authors.lastname: Nurk
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
authors.forename: Helga
authors.initials: H
authors.lastname: Refsum
authors.forename: Per M
authors.initials: PM
authors.lastname: Ueland
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D006710:Homocysteine