Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women.
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.
Rossi
Gian Paolo
GP
Department of Clinical and Experimental Medicine, Internal Medicine 4, University Hospital, Padua, Italy. gianpaolo.rossi@unipd.it
Maiolino
Giuseppe
G
Seccia
Teresa Maria
TM
Burlina
Alberto
A
Zavattiero
Silvia
S
Cesari
Maurizio
M
Sticchi
Daniele
D
Pedon
Luigi
L
Zanchetta
Mario
M
Pessina
Achille C
AC
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
D006710:Homocysteine; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2)