title: Coronary heart disease mortality, plasma homocysteine, and B-vitamins: a prospective study.
abstract: The results of prospective studies on the relations between the plasma concentration of total homocysteine (tHcy) and B-vitamins, on the one hand, and coronary heart disease (CHD) mortality, on the other hand, are inconclusive and scarce considering the relation with B-vitamins. We prospectively determined these relations in a case-cohort study. The full-cohort existed in approximately 36,000 Dutch adults aged 20-59 years at baseline. The statistical analyses were done with a random sample from the cohort (n=630) complemented with all subjects who died of CHD (n=102) during a mean follow-up of 10.3 years. All subjects reported the absence of cardiovascular diseases (CVDs) at baseline. The plasma concentrations of tHcy, folate, PLP, and vitamin B12 were determined in samples obtained at baseline. Men with a tHcy concentration in the highest tertile (T3) compared with men in the lowest tertile (T1) had a relative risk (RR) of 1.14 for CHD (95% confidence interval (CI): 0.50, 2.61) after adjusting for age, study center, hypertension, HDL and total cholesterol, smoking, and creatinine. For women, this RR was 2.04 (95% CI: 0.48, 8.62). For each 5 micromol/l increase in tHcy, the RR of CHD was 1.03 (95% CI: 0.83-1.29) for men and women combined. In women only, high folate levels were associated with a statistically significant protection of fatal CHD (T3 versus T1; RR: 0.22, 95% CI: 0.06, 0.87). Plasma PLP (B6) and vitamin B12 concentrations were not associated with CHD risk. We conclude that elevated tHcy concentrations do not seem to be a risk factor for CHD mortality in these relatively young healthy Dutch subjects free of baseline CVD. Higher folate concentrations may be protective of CHD, but this needs confirmation.
authors.affiliation: Department of Chronic Disease Epidemiology (pb 101), National Institute of Public Health and the Environment (RIVM), PO Box 1, NL-3720 BA Bilthoven, The Netherlands.
authors.forename: Angelika
authors.initials: A
authors.lastname: de Bree
authors.forename: W Monique M
authors.initials: WM
authors.lastname: Verschuren
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Blom
authors.forename: Marie
authors.initials: M
authors.lastname: Nadeau
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Trijbels
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006710:Homocysteine / Q000096:biosynthesis / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014803:Vitamin B Complex / Q000097:blood* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D014803:Vitamin B Complex