title: Serum homocysteine in relation to mortality and morbidity from coronary heart disease: a 24-year follow-up of the population study of women in Gothenburg.
abstract: BACKGROUND
  Elevated serum total homocysteine (tHcy) is an established risk factor for cardiovascular disease (CVD), especially in men. However, there are few prospective population studies on female cohorts, and none of these has been longer than 13 years.
  
  
  RESULTS
  The Population Study of Women in Gothenburg began in 1968/1969, at which time a representative population-based cohort of women aged 38, 46, 50, 54, and 60 years was recruited. The present cohort is a prospective follow-up of 1368 women in the original cohort for whom blood samples were stored and who were free of previous acute myocardial infarction (AMI) at the 1968/1969 baseline. Homocysteine was analyzed in 2001 with frozen serum from the baseline study and related to AMI incidence and mortality during 24 years of follow-up. Cox regression analyses were used with adjustment for age, traditional risk factors, and tHcy modifiers. For the fifth tHcy quintile, relative risk was 1.86 (95% CI 1.06 to 3.26) for AMI and 5.14 (95% CI 2.22 to 11.92) for death due to AMI. Age-standardized Kaplan-Meier plots for the fifth tHcy quintile versus others showed significant differences both for AMI and for death due to AMI that were apparent after 15 years of follow-up.
  
  
  CONCLUSIONS
  Homocysteine in middle-aged women is an independent risk factor for myocardial infarction and in particular mortality due to myocardial infarction. The study illustrates that long-term prospective studies might be necessary to show effects of homocysteine levels on AMI morbidity and mortality in women.
authors.affiliation: Department of Primary Health Care, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. dimitri.zylberstein@allmed.gu.se
authors.forename: Dimitri Edin
authors.initials: DE
authors.lastname: Zylberstein
authors.forename: Calle
authors.initials: C
authors.lastname: Bengtsson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
authors.forename: Sverre
authors.initials: S
authors.lastname: Landaas
authors.forename: Valter
authors.initials: V
authors.lastname: Sundh
authors.forename: Dag
authors.initials: D
authors.lastname: Thelle
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D006710:Homocysteine