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Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events
Elevated homocysteine levels are associated with increased coronary risk, and it has been suggested that homocysteine screening may provide a method to identify high-risk patients for aggressive primary prevention. Homocysteine was measured at baseline and after 1 year among 5569 participants in the...
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| Published in: | Circulation (New York, N.Y.) N.Y.), 2002-04, Vol.105 (15), p.1776-1779 |
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| cites | cdi_FETCH-LOGICAL-c467t-5f70f1a68046ec436a4962473593ad38c8776d13c17e1f2130748262e7830b653 |
| container_end_page | 1779 |
| container_issue | 15 |
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| container_title | Circulation (New York, N.Y.) |
| container_volume | 105 |
| creator | RIDKER, Paul M SHIH, Jessie COOK, Thomas J CLEARFIELD, Michael DOWNS, John R PRADHAN, Aruna D WEIS, Stephan E GOTTO, Antonio M |
| description | Elevated homocysteine levels are associated with increased coronary risk, and it has been suggested that homocysteine screening may provide a method to identify high-risk patients for aggressive primary prevention.
Homocysteine was measured at baseline and after 1 year among 5569 participants in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a randomized trial of lovastatin in the primary prevention of acute coronary events. The effects of homocysteine, LDL cholesterol, and lovastatin on risk were assessed over 5.2 years of trial follow-up. Median baseline homocysteine levels were significantly higher among study participants who subsequently had acute coronary events compared with those who did not (12.1 versus 10.9 micro;mol/L, P |
| doi_str_mv | 10.1161/01.CIR.0000014447.06099.FB |
| format | article |
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Homocysteine was measured at baseline and after 1 year among 5569 participants in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a randomized trial of lovastatin in the primary prevention of acute coronary events. The effects of homocysteine, LDL cholesterol, and lovastatin on risk were assessed over 5.2 years of trial follow-up. Median baseline homocysteine levels were significantly higher among study participants who subsequently had acute coronary events compared with those who did not (12.1 versus 10.9 micro;mol/L, P<0.001). The relative risks of future events from lowest (referent) to highest quartile of homocysteine were 1.0, 1.6, 1.6, and 2.2 (P<0.001). These effects were similar among those allocated to lovastatin and those allocated to placebo and were modestly attenuated after adjustment for other traditional risk factors. As predicted, the subgroup of participants with elevated LDL cholesterol and elevated homocysteine levels were at high risk and benefited greatly from statin therapy (relative risk, 0.46; 95% CI, 0.29 to 0.75; number needed to treat=26). However, in contrast to findings in this trial for C-reactive protein, homocysteine evaluation did not help to define low LDL subgroups with different responses to lovastatin therapy.
Although homocysteine predicted future coronary events in AFCAPS/TexCAPS, we found little evidence that homocysteine evaluation provided an improved method to target statin therapy among those with low-to-normal LDL cholesterol levels.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000014447.06099.FB</identifier><identifier>PMID: 11956118</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Aged ; Anticholesteremic Agents - therapeutic use ; Biological and medical sciences ; C-Reactive Protein - analysis ; Cholesterol, LDL - blood ; Coronary Artery Disease - prevention & control ; Coronary Disease - diagnosis ; Coronary Disease - prevention & control ; Double-Blind Method ; Female ; Follow-Up Studies ; General and cellular metabolism. Vitamins ; Homocysteine - blood ; Humans ; Lovastatin - therapeutic use ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnosis ; Pharmacology. Drug treatments ; Risk Factors</subject><ispartof>Circulation (New York, N.Y.), 2002-04, Vol.105 (15), p.1776-1779</ispartof><rights>2002 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Apr 16, 2002</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-5f70f1a68046ec436a4962473593ad38c8776d13c17e1f2130748262e7830b653</citedby><cites>FETCH-LOGICAL-c467t-5f70f1a68046ec436a4962473593ad38c8776d13c17e1f2130748262e7830b653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13623458$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11956118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RIDKER, Paul M</creatorcontrib><creatorcontrib>SHIH, Jessie</creatorcontrib><creatorcontrib>COOK, Thomas J</creatorcontrib><creatorcontrib>CLEARFIELD, Michael</creatorcontrib><creatorcontrib>DOWNS, John R</creatorcontrib><creatorcontrib>PRADHAN, Aruna D</creatorcontrib><creatorcontrib>WEIS, Stephan E</creatorcontrib><creatorcontrib>GOTTO, Antonio M</creatorcontrib><creatorcontrib>Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) Investigators</creatorcontrib><title>Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Elevated homocysteine levels are associated with increased coronary risk, and it has been suggested that homocysteine screening may provide a method to identify high-risk patients for aggressive primary prevention.
Homocysteine was measured at baseline and after 1 year among 5569 participants in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a randomized trial of lovastatin in the primary prevention of acute coronary events. The effects of homocysteine, LDL cholesterol, and lovastatin on risk were assessed over 5.2 years of trial follow-up. Median baseline homocysteine levels were significantly higher among study participants who subsequently had acute coronary events compared with those who did not (12.1 versus 10.9 micro;mol/L, P<0.001). The relative risks of future events from lowest (referent) to highest quartile of homocysteine were 1.0, 1.6, 1.6, and 2.2 (P<0.001). These effects were similar among those allocated to lovastatin and those allocated to placebo and were modestly attenuated after adjustment for other traditional risk factors. As predicted, the subgroup of participants with elevated LDL cholesterol and elevated homocysteine levels were at high risk and benefited greatly from statin therapy (relative risk, 0.46; 95% CI, 0.29 to 0.75; number needed to treat=26). However, in contrast to findings in this trial for C-reactive protein, homocysteine evaluation did not help to define low LDL subgroups with different responses to lovastatin therapy.
Although homocysteine predicted future coronary events in AFCAPS/TexCAPS, we found little evidence that homocysteine evaluation provided an improved method to target statin therapy among those with low-to-normal LDL cholesterol levels.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Anticholesteremic Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>C-Reactive Protein - analysis</subject><subject>Cholesterol, LDL - blood</subject><subject>Coronary Artery Disease - prevention & control</subject><subject>Coronary Disease - diagnosis</subject><subject>Coronary Disease - prevention & control</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General and cellular metabolism. Vitamins</subject><subject>Homocysteine - blood</subject><subject>Humans</subject><subject>Lovastatin - therapeutic use</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Pharmacology. Drug treatments</subject><subject>Risk Factors</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><recordid>eNpdkVFLIzEQx8OhnLX6FY5Q8J7cNZNkk13fzmLvBEERfTXENIvb201qkhX67U2vhcLNS2aY33-SyR-hGZASQMAVgXJ-91SSbQDnXJZEkKYpFzff0AQqygteseYITXK_KSSj9ASdxrjKpWCy-o5OAJpKANQT9PrY6zho_O4HbzYx2c5ZbLwz1qWgU-fdJY4pJw6ndxv0enOJtVtuCxy6-Bf7FrddiAlrM6atNHinwwbbzzwhnqHjVvfRnu_PKXpZ3D7P_xT3D7_v5r_uC8OFTEXVStKCFjXhwhrOhOaNoFyyqmF6yWpTSymWwAxICy0FRiSvqaBW1oy8iYpN0c_d3HXwH6ONSQ1dNLbvtbN-jEqCIABMZnD2H7jyY3D5bYoCFTXPTIaud5AJPsZgW7UO3ZC3UkDU1gJFQGUL1MEC9c8CtbjJ4h_7G8a3wS4P0v2fZ-BiD-hodN8G7UwXDxwTlPGqZl-S3o36</recordid><startdate>20020416</startdate><enddate>20020416</enddate><creator>RIDKER, Paul M</creator><creator>SHIH, Jessie</creator><creator>COOK, Thomas J</creator><creator>CLEARFIELD, Michael</creator><creator>DOWNS, John R</creator><creator>PRADHAN, Aruna D</creator><creator>WEIS, Stephan E</creator><creator>GOTTO, Antonio M</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20020416</creationdate><title>Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events</title><author>RIDKER, Paul M ; SHIH, Jessie ; COOK, Thomas J ; CLEARFIELD, Michael ; DOWNS, John R ; PRADHAN, Aruna D ; WEIS, Stephan E ; GOTTO, Antonio M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-5f70f1a68046ec436a4962473593ad38c8776d13c17e1f2130748262e7830b653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Anticholesteremic Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>C-Reactive Protein - analysis</topic><topic>Cholesterol, LDL - blood</topic><topic>Coronary Artery Disease - prevention & control</topic><topic>Coronary Disease - diagnosis</topic><topic>Coronary Disease - prevention & control</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General and cellular metabolism. Vitamins</topic><topic>Homocysteine - blood</topic><topic>Humans</topic><topic>Lovastatin - therapeutic use</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Pharmacology. Drug treatments</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RIDKER, Paul M</creatorcontrib><creatorcontrib>SHIH, Jessie</creatorcontrib><creatorcontrib>COOK, Thomas J</creatorcontrib><creatorcontrib>CLEARFIELD, Michael</creatorcontrib><creatorcontrib>DOWNS, John R</creatorcontrib><creatorcontrib>PRADHAN, Aruna D</creatorcontrib><creatorcontrib>WEIS, Stephan E</creatorcontrib><creatorcontrib>GOTTO, Antonio M</creatorcontrib><creatorcontrib>Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) Investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RIDKER, Paul M</au><au>SHIH, Jessie</au><au>COOK, Thomas J</au><au>CLEARFIELD, Michael</au><au>DOWNS, John R</au><au>PRADHAN, Aruna D</au><au>WEIS, Stephan E</au><au>GOTTO, Antonio M</au><aucorp>Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2002-04-16</date><risdate>2002</risdate><volume>105</volume><issue>15</issue><spage>1776</spage><epage>1779</epage><pages>1776-1779</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Elevated homocysteine levels are associated with increased coronary risk, and it has been suggested that homocysteine screening may provide a method to identify high-risk patients for aggressive primary prevention.
Homocysteine was measured at baseline and after 1 year among 5569 participants in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a randomized trial of lovastatin in the primary prevention of acute coronary events. The effects of homocysteine, LDL cholesterol, and lovastatin on risk were assessed over 5.2 years of trial follow-up. Median baseline homocysteine levels were significantly higher among study participants who subsequently had acute coronary events compared with those who did not (12.1 versus 10.9 micro;mol/L, P<0.001). The relative risks of future events from lowest (referent) to highest quartile of homocysteine were 1.0, 1.6, 1.6, and 2.2 (P<0.001). These effects were similar among those allocated to lovastatin and those allocated to placebo and were modestly attenuated after adjustment for other traditional risk factors. As predicted, the subgroup of participants with elevated LDL cholesterol and elevated homocysteine levels were at high risk and benefited greatly from statin therapy (relative risk, 0.46; 95% CI, 0.29 to 0.75; number needed to treat=26). However, in contrast to findings in this trial for C-reactive protein, homocysteine evaluation did not help to define low LDL subgroups with different responses to lovastatin therapy.
Although homocysteine predicted future coronary events in AFCAPS/TexCAPS, we found little evidence that homocysteine evaluation provided an improved method to target statin therapy among those with low-to-normal LDL cholesterol levels.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>11956118</pmid><doi>10.1161/01.CIR.0000014447.06099.FB</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2002-04, Vol.105 (15), p.1776-1779 |
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| language | eng |
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| source | Free E-Journal (出版社公開部分のみ） |
| subjects | Acute Disease Aged Anticholesteremic Agents - therapeutic use Biological and medical sciences C-Reactive Protein - analysis Cholesterol, LDL - blood Coronary Artery Disease - prevention & control Coronary Disease - diagnosis Coronary Disease - prevention & control Double-Blind Method Female Follow-Up Studies General and cellular metabolism. Vitamins Homocysteine - blood Humans Lovastatin - therapeutic use Male Medical sciences Middle Aged Myocardial Infarction - diagnosis Pharmacology. Drug treatments Risk Factors |
| title | Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events |
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