Hyperhomocysteinemia is inversely related with left ventricular ejection fraction and predicts cardiovascular mortality in high-risk coronary artery disease hypertensives.
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.
Cesari
Maurizio
M
DMCS Clinica Medica 4, University of Padova, Italy.
Zanchetta
Mario
M
Burlina
Alberto
A
Pedon
Luigi
L
Maiolino
Giuseppe
G
Sticchi
Daniele
D
Pessina
Achille C
AC
Rossi
Gian Paolo
GP
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*
D045102:Methylenetetrahydrofolate Dehydrogenase (NAD+)