title: Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women.
abstract: OBJECTIVE
  The impact of homocysteine on cardiovascular disease can be more detrimental in women than in men, but it is unknown whether this applies to high-risk women. We therefore investigated the association of hyperhomocysteinemia with coronary artery disease (CAD) and cardiovascular mortality in high-risk women referred for CAD, both in the total population and in the hypertensive and normotensive cohorts.
  
  
  METHODS
  A prospective study cohort.
  
  
  METHODS
  A tertiary centre.
  
  
  METHODS
  
  
  
  METHODS
  262 consecutive Caucasian postmenopausal women referred for coronary angiography.
  
  
  METHODS
  acute myocardial infarction and vitamin supplementation.
  
  
  METHODS
  We assessed total plasma homocysteine (tHcy), folate levels, and the MTHFR677C-->T polymorphism. CAD was defined as a modified Duke Index score greater than 0; hyperhomocysteinemia as tHcy levels of 15 micromol/l or greater. The primary study outcome was cardiovascular mortality at follow-up.
  
  
  RESULTS
  Mild/moderate and severe hyperhomocysteinemia was found in 15.1 and 1.6% of women, respectively, without differences between CAD and non-CAD women. By the ATPIII criteria, 92.2% of the women were in the highest risk class and 55% had CAD; however, no association of tHcy with the CAD score was found. After a median follow-up of 3.6 years, 23 women (9.1%) had died, 15 (6%) of cardiovascular causes. Women with high tHcy levels showed the worst all-cause and cardiovascular death-free survival at Kaplan-Meier and Cox regression analysis. Moreover, in the hypertensive cohort only women with hyperhomocysteinemia showed increased cardiovascular mortality.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia is common in high-risk women and adversely affects their prognosis, although it is unrelated to the CAD atherosclerotic burden.
authors.affiliation: Department of Clinical and Experimental Medicine, Internal Medicine 4, University Hospital, Padua, Italy. gianpaolo.rossi@unipd.it
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maiolino
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Seccia
authors.forename: Alberto
authors.initials: A
authors.lastname: Burlina
authors.forename: Silvia
authors.initials: S
authors.lastname: Zavattiero
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cesari
authors.forename: Daniele
authors.initials: D
authors.lastname: Sticchi
authors.forename: Luigi
authors.initials: L
authors.lastname: Pedon
authors.forename: Mario
authors.initials: M
authors.lastname: Zanchetta
authors.forename: Achille C
authors.initials: AC
authors.lastname: Pessina
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000378:metabolism* / Q000473:pathology*; D008137:Longitudinal Studies; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D011110:Polymorphism, Genetic; D017698:Postmenopause; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D044465:White People
chemical_list: D006710:Homocysteine; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2)