title: Interaction between homocysteine and lipoprotein(a) increases the prevalence of coronary artery disease/myocardial infarction in women: a case-control study.
abstract: BACKGROUND
  Our aim was to investigate the association of elevated homocysteine (Hcy) and lipoprotein(a) Lp(a) with the prevalence of coronary artery disease (CAD) and myocardial infarction (MI) and to investigate their interaction in both genders.
  
  
  METHODS
  955 (male/female: 578/377) consecutive patients admitted for coronary angiography were enrolled in the study. Lp(a), Hcy, vitamin B12, folic acid, MTHFR C677T polymorphism and traditional risk factors were determined.
  
  
  RESULTS
  619 patients had significant (≥50%) stenosis (CAD+) and 341 had MI (MI+). CAD-MI- cases (n=302) were considered as controls. Adjusted Hcy levels were significantly elevated only in the female CAD+MI+group that was related to decreased vitamin B12 levels. Lp(a) was elevated in the CAD+MI+group of both genders. Folic acid levels and MTHFR T677 allele frequency did not show significant difference. Moderate hyperhomocysteinemia (Hcy >15μmol/L) or elevated Lp(a) (>300mg/L) increased the risk of CAD (OR 2.27, CI 1.36-3.80 and OR 1.64, CI 1.03-2.61, respectively) and MI (OR 2.52, CI 1.36-4.67 and OR 1.89, CI 1.06-3.38, respectively) only in women. Only simultaneous but not isolated elevation of Hcy and Lp(a) conferred a significant, 3.6-fold risk of CAD in females and even higher (11-fold) risk in young females, which suggested an interactive effect.
  
  
  CONCLUSIONS
  Moderate hyperhomocysteinemia or elevated Lp(a) level associated with a risk of CAD and MI only in women. While isolated elevation of one of the two parameters represented a mild risk of CAD, their combined elevation highly increased the risk in females. No such effect was observed in males.
authors.affiliation: Department of Cardiology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. baloghemiliadr@gmail.com
authors.forename: Emilia
authors.initials: E
authors.lastname: Balogh
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Bereczky
authors.forename: Eva
authors.initials: E
authors.lastname: Katona
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Koszegi
authors.forename: István
authors.initials: I
authors.lastname: Edes
authors.forename: László
authors.initials: L
authors.lastname: Muszbek
authors.forename: István
authors.initials: I
authors.lastname: Czuriga
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013223:Statistics as Topic
chemical_list: D015415:Biomarkers; D017270:Lipoprotein(a); D006710:Homocysteine