Plasma total homocysteine levels and prognosis in patients with previous premature myocardial infarction: a 10-year follow-up study.
OBJECTIVE
To explore plasma total homocysteine (tHcy) as a predictor of long-term prognosis after premature myocardial infarction (MI).


METHODS
Prospective cohort study.


METHODS
Akershus University Hospital.


METHODS
A total of 247 patients (193 men and 54 women) in stable clinical phase after premature MI (males: first MI at age < or =55; females < or =60).


METHODS
The primary end-point was total mortality and the secondary end-point was cardiac death. The third end-point was major cardiac events: a combination of cardiac death, MI and cardiac arrest.


RESULTS
After 10 years, 44 patients had died, 36 from cardiac causes. Major cardiac event occurred in 70 patients. The relative risk for death of all causes increased 1.43 (95% CI, 1.08-1.88) per tHcy quartile (P for trend = 0.01), and was only modestly reduced after adjustment for age, ejection fraction, total cholesterol, C-reactive protein, fibrinogen, smoking and hypertension to 1.37 (95% CI, 1.04-1.80) (P for trend = 0.03). Similar results were observed when cardiac death was used as the end-point, but we observed no association between tHcy and the end-point major cardiac event.


CONCLUSIONS
Total homocysteine was an independent predictor of total and cardiac mortality in stable patients following premature MI. tHcy had no effect on major cardiac event in contrast to most other risk factors in this study. Thus, the mechanism(s) underlying the effects of homocysteine on coronary heart disease may differ from other risk factors.
Retterstol
L
L
Institute of Medical Genetics, University of Oslo, Oslo, Norway. l.j.retterstol@ioks.uio.no
Paus
B
B
Bohn
M
M
Bakken
A
A
Erikssen
J
J
Malinow
M R
MR
Berg
K
K
D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D015415:Biomarkers; D006710:Homocysteine