title: Hyperhomocysteinaemia is associated with coronary events in type 2 diabetes.
abstract: OBJECTIVE
  Amongst nondiabetic individuals, a high serum homocysteine concentration is an independent but relatively weak risk factor for coronary events. However, it is not known whether homocysteine increases risk of coronary events in type 2 diabetes. Therefore, we examined the combined effect of homocysteine and type 2 diabetes on risk of fatal and nonfatal coronary events.
  
  
  METHODS
  We assessed the 10-year risk of coronary events associated with homocysteine amongst diabetic (n = 140) and nondiabetic (n = 361) individuals.
  
  
  METHODS
  We did this in the Hoorn Study, a population-based study of glucose tolerance and related complications in Caucasian men and women aged 50-75 years.
  
  
  RESULTS
  The incidence rate for coronary events was 2.63 (29 of 140) per 100 person-years amongst diabetic and 1.29 (42 of 361) amongst nondiabetic individuals. Amongst diabetic individuals, risk of coronary events increased 28% for each 5-micromol L(-1) increment of homocysteine (hazard ratio, 1.28; 95% CI, 1.02-1.58). This risk was independent of age, sex, hypertension, total cholesterol, HDL-cholesterol, cigarette smoking, body mass index and glomerular filtration rate. In nondiabetic participants, homocysteine was not associated with an increased risk of coronary events (hazard ratio for each 5-micromol L(-1) increment of homocysteine, 0.86; 0.52-1.41).
  
  
  CONCLUSIONS
  These data suggest that homocysteine is significantly associated with coronary events in individuals with type 2 diabetes, independent of traditional cardiovascular risk factors. Investigation of the effect of treatment with vitamin B on prognosis of individuals with type 2 diabetes is warranted.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: P J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: G
authors.initials: G
authors.lastname: Bos
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: J M
authors.initials: JM
authors.lastname: Dekker
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications*; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors