title: Hyperhomocysteinemia is inversely related with left ventricular ejection fraction and predicts cardiovascular mortality in high-risk coronary artery disease hypertensives.
abstract: OBJECTIVE
  The purpose of this study was to investigate the relationship of plasma homocysteine (tHcy) levels with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) in high-risk patients undergoing coronary angiography for suspected CAD.
  
  
  RESULTS
  In 936 consecutive patients, we measured LVEF, tHcy, folate levels, and quantified CAD with a modified Duke Index score. We also genotyped patients at the methylen-tetrahydrofolate-reductase 677C-->T polymorphism. Hyperhomocysteinemia (HHcy) was defined as tHcy levels > or =15.46 micromol/L; total and cardiovascular mortality was assessed at follow-up that lasted 43 months (median). CAD was confirmed in 75% of patients and ruled out in the rest (non-CAD group). No relationship of HHcy with either arterial hypertension or the CAD score was found. In contrast, there was a significant inverse relationship of tHcy with LVEF in arterial hypertensive but not in normotensive patients, regardless of previous myocardial infarction. At logistic regression, HHcy was the strongest predictor (P=0.001) of a low (<40%) LVEF, followed by type 2 diabetes mellitus and cigarette smoking. At follow-up, HHcy significantly predicted cardiovascular mortality but only in the arterial hypertension subgroup.
  
  
  CONCLUSIONS
  In arterial hypertensive but not in normotensive patients, HHcy predicts cardiovascular mortality and a low LVEF, independent of CAD and history of myocardial infarction.
authors.affiliation: DMCS Clinica Medica 4, University of Padova, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cesari
authors.forename: Mario
authors.initials: M
authors.lastname: Zanchetta
authors.forename: Alberto
authors.initials: A
authors.lastname: Burlina
authors.forename: Luigi
authors.initials: L
authors.lastname: Pedon
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maiolino
authors.forename: Daniele
authors.initials: D
authors.lastname: Sticchi
authors.forename: Achille C
authors.initials: AC
authors.lastname: Pessina
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D020138:Hyperhomocysteinemia / Q000378:metabolism* / Q000473:pathology*; D008137:Longitudinal Studies; D045102:Methylenetetrahydrofolate Dehydrogenase (NAD+); D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000378:metabolism; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D045102:Methylenetetrahydrofolate Dehydrogenase (NAD+)