Elevated plasma homocysteine: cause or consequence of myocardial infarction?
OBJECTIVE
To determine whether a first myocardial infarction leads to increased plasma homocysteine concentrations and whether the association between homocysteine and myocardial infarction was greater at follow-up compared with baseline.


METHODS
A population-based, prospective, nested case-referent study.


METHODS
Screening took place at the nearest health survey centre in northern Sweden.


METHODS
Of more than 36,000 persons screened, 78 developed a first myocardial infarction (average 18 months after sampling). Fifty of these had participated in a follow-up health survey (average 8(1/2) years between surveys) and were sex- and age-matched with 56 referents.


METHODS
Comparison of plasma homocysteine levels in case and referent subjects before and after development of a first myocardial infarction.


RESULTS
No statistically significant difference was found between cases and referents regarding homocysteine at baseline or follow-up. Plasma homocysteine and plasma creatinine increased significantly, and plasma albumin decreased significantly over time. Conditional univariate logistic regression indicated that high homocysteine at follow-up but not baseline was associated with first myocardial infarction (OR 2.49; 95% CI: 1.03-6.02), but the relation disappeared in multivariate analyses including plasma creatinine and plasma albumin. High plasma creatinine remained associated with first myocardial infarction at both baseline (OR 2.94; 95% CI: 1.05-8.21) and follow-up (OR 3.38; 95% CI: 1.21-9.48).


CONCLUSIONS
In this study, first myocardial infarction did not cause increased plasma homocysteine concentration.
Hultdin
J
J
Department of Medical Biosciences, Clinical Chemistry, Umeå University Hospital, Umeå, Sweden.
Thøgersen
A M
AM
Jansson
J-H
JH
Nilsson
T K
TK
Weinehall
L
L
Hallmans
G
G
D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012907:Smoking / Q000009:adverse effects
D012709:Serum Albumin; D006710:Homocysteine; D003404:Creatinine