title: Hyperhomocysteinemia and mortality after coronary artery bypass grafting.
abstract: BACKGROUND
  The independent prognostic impact, as well as the possible causal role, of hyperhomocysteinemia (HHcy) in coronary artery disease (CAD) is controversial. No previous study specifically has addressed the relationship between HHcy and mortality after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the prognostic impact of HHcy after CABG surgery.
  
  
  RESULTS
  We prospectively followed 350 patients who underwent elective CABG between May 1996 and May 1999. At baseline, fasting total homocysteine (tHcy) levels were measured in all participants, and a post-methionine loading (PML) test was performed in 77.7% of them (n = 272). After a median follow-up of 58 months, 33 patients (9.4%) had died, 25 because of cardiovascular events. HHcy, defined by levels higher than the 90th percentile (25.2 micromol/L) of the population's distribution, was significantly associated to total and cardiovascular mortality (P = 0.018 [log-rank test 5.57]; P = 0.002 [log-rank test 9.76], respectively). The PML test had no prognostic value. After multiple adjustment for other univariate predictors by Cox regression, including statin therapy (the most powerful predictor in uni-/multivariate analyses), high-sensitivity C Reactive Protein (hs-CRP) levels, and all known major genetic (MTHFR 677C-->T polymorphism) and non-genetic (B-group vitamin status and renal function) tHcy determinants, HHcy remained an independent prognostic factor for mortality (HRs: 5.02, 95% CIs 1.88 to 13.42, P = 0.001).
  
  
  CONCLUSIONS
  HHcy is an important prognostic marker after CABG, independent of modern drug therapy and biomarkers.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Verona, Italy. domenico.girelli@univr.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Girelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Martinelli
authors.forename: Oliviero
authors.initials: O
authors.lastname: Olivieri
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzolo
authors.forename: Simonetta
authors.initials: S
authors.lastname: Friso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Faccini
authors.forename: Claudia
authors.initials: C
authors.lastname: Bozzini
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tenuti
authors.forename: Valentina
authors.initials: V
authors.lastname: Lotto
authors.forename: Giuliano
authors.initials: G
authors.lastname: Villa
authors.forename: Patrizia
authors.initials: P
authors.lastname: Guarini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Trabetti
authors.forename: Pier Franco
authors.initials: PF
authors.lastname: Pignatti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
authors.forename: Roberto
authors.initials: R
authors.lastname: Corrocher
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005838:Genotype; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications* / Q000201:enzymology / Q000235:genetics; D007558:Italy / Q000453:epidemiology; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006710:Homocysteine; D042965:Methylenetetrahydrofolate Reductase (NADPH2)