title: Influence of high homocysteine and low folate plasmatic levels in medium-term prognosis after acute coronary syndromes.
abstract: BACKGROUND
  To test prospectively whether moderate hyperhomocysteinemia and low folate levels could have an influence in the prognosis of 155 patients who presented with an acute coronary syndrome.
  
  
  RESULTS
  After a mean follow-up of 13.4+/-7.4 months, patients with low folate levels had higher percentages of cardiovascular death and major cardiovascular events (33% vs. 5%, p<0.001; 44% vs. 22%, p<0.05) and patients with high homocysteine levels had a higher percentage of major cardiovascular events (31% vs. 14.5%, p<0.03). Kaplan-Meier survival estimates analysis showed that patients with low folate levels had a significantly higher probability of cardiovascular death and lower free-of-events survival (log rank statistic: 21.17, p<0.001 and 6.59, p=0.01). Patients with high homocysteine levels had a lower free-of-events survival (log rank statistic: 4.95, p=0.02). Different survival multivariate analysis model showed that the presence of low folate levels was an independent predictor of cardiovascular death (hazard ratio 8.85, 95% confidence interval 2.6-29.3, p<0.000) and high homocysteine levels was identified as independent predictor of major cardiovascular events (hazard ratio 2.34, 95% confidence interval 1.07-5.12, p<0.03).
  
  
  CONCLUSIONS
  Low folate levels and moderate hyperhomocysteinemia were identified as independent predictors of cardiovascular events in the follow-up.
authors.affiliation: Cardiology Department, Hospital Universitario Virgen de la Victoria, School of Medicine, University of Malaga, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: García-Pinilla
authors.forename: Salvador
authors.initials: S
authors.lastname: Espinosa-Caliani
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gómez-Doblas
authors.forename: Manuel
authors.initials: M
authors.lastname: Jiménez-Navarro
authors.forename: María J
authors.initials: MJ
authors.lastname: Gaitán
authors.forename: Encarnación
authors.initials: E
authors.lastname: Muñoz-Morán
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabrera-Bueno
authors.forename: José M
authors.initials: JM
authors.lastname: Hernández-García
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Ortega-Jiménez
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Ruiz-Galdón
authors.forename: Armando
authors.initials: A
authors.lastname: Reyes-Engel
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Teresa-Galván
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005494:Folic Acid Deficiency / Q000097:blood* / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis