Homocysteine and risk of coronary artery disease: Folate is the important determinant of plasma homocysteine concentration.
OBJECTIVE
The purposes of this study were to study the effects of folate and vitamins B6 and B12 on plasma homocysteine concentration and to estimate the risks for coronary artery disease (CAD) according to quartiles of plasma homocysteine concentration.


METHODS
The study was designed as a case-reference observational study. Case subjects (CAD group, n = 60) were identified by cardiac catheterization to have at least 70% stenosis of one major coronary artery; otherwise, patients were considered for a reference group (n = 60). Risk factors of cardiovascular disease were recorded, including age, sex, blood lipid profile, hypertension, smoking habits, and drinking habits. Plasma homocysteine, folate, pyridoxal 5'-phosphate, and vitamin B12 were measured.


RESULTS
CAD subjects had significantly higher mean plasma homocysteine concentrations than did the reference subjects (13.9 +/- 4.9 versus 9.1 +/- 3.3 micromol/L). There were no significant differences between groups with regard to the three B vitamins; however, mean serum folate concentrations for subjects in the highest two quartiles of plasma homocysteine concentration (10.8-13.8 and >/=13.9 micromol/L) were significantly lower than those for subjects in the lowest two quartiles (</=8.0 and 8.1-10.7 micromol/L). Plasma homocysteine was strongly inversely associated with serum folate in the CAD (beta= -0.166, P < 0.05), reference (beta= -0.178, P < 0.001), and pooled (beta = -0.190, P < 0.001) groups. Age, sex, other confounding factors, and B-vitamin-adjusted odds ratios were significantly increased in the highest quartile of homocysteine concentration (odds ration, 5.54; 95% confidence interval, 0.38-81.41). The elevation of 1 ng/mL in serum folate concentration was found to decrease plasma homocysteine by 0.166 micromol/L.


CONCLUSIONS
Serum folate, but not vitamin B6 or B12, was a strong predictor of plasma homocysteine; while all subjects had adequate B-vitamin status. Folate should be considered as a routine supplementation for individuals who have risk factors for CAD, even for individuals with adequate folate status.
Lee
Bor Jen
BJ
Intensive Care Unit, Critical Care and Respiratory Therapy, Taichung Veterans General Hospital, Taiwan, People's Republic of China.
Lin
Ping Ting
PT
Liaw
Yung Po
YP
Chang
Sue Joan
SJ
Cheng
Chien Hsiung
CH
Huang
Yi Chia
YC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D014805:Vitamin B 12 / Q000097:blood; D025101:Vitamin B 6 / Q000097:blood
D006710:Homocysteine; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12