title: Elevated homocysteine levels and risk of cardiovascular and all-cause mortality: a meta-analysis of prospective studies.
abstract: OBJECTIVE
  To investigate whether elevated homocysteine levels were a predictor of subsequent coronary heart disease (CHD) mortality, cardiovascular mortality or all-cause mortality in the general population by a meta-analysis.
  
  
  METHODS
  In a systematic search conducted in the databases of PubMed and Embase prior to October 2013, we identified relevant prospective observational studies evaluating the association between baseline homocysteine levels and CHD mortality, cardiovascular or all-cause mortality in the general population. Pooled adjust risk ratio (RR) and corresponding 95% confidence interval (CI) were calculated separately for categorical risk estimates and continuous risk estimates.
  
  
  RESULTS
  Twelve studies with 23623 subjects were included in the meta-analysis. Comparing the highest to lowest homocysteine level categories, CHD mortality increased by 66% (RR 1.66; 95% CI 1.12-2.47; P=0.012), cardiovascular mortality increased by 68% (RR 1.68; 95% CI 1.04-2.70; P=0.033), and all-cause mortality increased by 93% (RR 1.93; 95% CI 1.54-2.43; P<0.001). Moreover, for each 5 μmol/L homocysteine increment, the pooled RR was 1.52 (95% CI 1.26-1.84; P<0.001) for CHD mortality, 1.32 (95% CI 1.08-1.61; P=0.006) for cardiovascular mortality, and 1.27 (95% CI 1.03-1.55; P=0.023) for all-cause mortality.
  
  
  CONCLUSIONS
  Elevated homocysteine levels are an independent predictor for subsequent cardiovascular mortality or all-cause mortality, and the risks were more pronounced among elderly persons.
authors.affiliation: Cancer Institute, the Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China.
authors.forename: Hui-yong
authors.initials: HY
authors.lastname: Peng
authors.forename: Chang-feng
authors.initials: CF
authors.lastname: Man
authors.forename: Juan
authors.initials: J
authors.lastname: Xu
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D003327:Coronary Disease / Q000097:blood / Q000401:mortality; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D064887:Observational Studies as Topic; D016017:Odds Ratio; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006710:Homocysteine
keywords: All-cause mortality; Cardiovascular mortality; Coronary heart disease; Homocysteine; Meta-analysis