title: Homocysteine level is associated with aortic stiffness in elderly: cross-sectional results from the B-PROOF study.
abstract: OBJECTIVE
  Homocysteine has been shown to be a more accurate predictor of cardiovascular mortality in very old persons than models based on classical risk factors. Arterial stiffening is a structural abnormality involved in the pathway of cardiovascular disease. We expect this underlying pathophysiology to be a possible explanation for the association between homocysteine and cardiovascular risk, particularly in older populations.
  
  
  METHODS
  Baseline cross-sectional data of the B-PROOF study were used to determine associations between homocysteine and outcomes of vascular function and structure. The cardiovascular subgroup of the B-PROOF study was included [n = 560, 58% men, age 72.6 ± 5.5 years, median homocysteine level 14.2 μmol/l (IQR 13.0-16.6)]. We assessed carotid distensibility coefficient, carotid compliance coefficient, aortic pulse wave velocity (aPWV), augmentation index (AIx) and aortic pulse pressure (aortic PP). Associations were tested using linear regression analysis and ANCOVA and were adjusted for possible confounders including age, sex, renal function, mean arterial pressure and heart rate.
  
  
  RESULTS
  Ln-homocysteine was strongly associated with aPWV [β 0.005 95% confidence interval (0.001-0.009)]. Furthermore, this association was shown to be age-dependent (P = 0.02) and it was most strong in the upper tertile of age (77-98 years). No significant associations with ln-homocysteine were observed for AIx, carotid distensibility coefficient and compliance coefficient and aortic PP. Sex stratification shows the association between ln-homocysteine and aPWV is only significant in men.
  
  
  CONCLUSIONS
  In older persons, homocysteine is associated with aortic stiffness, predominantly in the oldest old. This suggests that the strong association between homocysteine and cardiovascular mortality in the elderly may be mediated by aortic stiffness.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands. s.c.vandijk@erasmusmc.nl
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: van Dijk
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.forename: Anke W
authors.initials: AW
authors.lastname: Enneman
authors.forename: Karin M A
authors.initials: KM
authors.lastname: Swart
authors.forename: Janneke P
authors.initials: JP
authors.lastname: van Wijngaarden
authors.forename: Annelies C
authors.initials: AC
authors.lastname: Ham
authors.forename: Natasja M
authors.initials: NM
authors.lastname: van Schoor
authors.forename: Rosalie A M
authors.initials: RA
authors.lastname: Dhonukshe-Rutten
authors.forename: Lisette C P G M
authors.initials: LC
authors.lastname: de Groot
authors.forename: Paul
authors.initials: P
authors.lastname: Lips
authors.forename: Andre G
authors.initials: AG
authors.lastname: Uitterlinden
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Blom
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.forename: Edith J
authors.initials: EJ
authors.lastname: Feskens
authors.forename: Anton H
authors.initials: AH
authors.lastname: van den Meiracker
authors.forename: Francesco U S
authors.initials: FU
authors.lastname: Mattace Raso
authors.forename: Nathalie
authors.initials: N
authors.lastname: van der Velde
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness
chemical_list: D006710:Homocysteine