Plasma total homocysteine levels and prognosis in patients with previous premature myocardial infarction: a 10‐year follow‐up study

• Published in: Journal of internal medicine 2003-03, Vol.253 (3), p.284-292
• Main Authors: Retterstol, L., Paus, B., Bohn, M., Bakken, A., Erikssen, J., Malinow, M. R., Berg, K.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cohort Studies; Coronary heart disease; Death, Sudden, Cardiac - etiology; Female; Follow-Up Studies; Heart; homocysteine; Homocysteine - blood; Humans; Male; Medical sciences; Middle Aged; myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - mortality; Prognosis; Prospective Studies; risk factor; Risk Factors; Survival Analysis
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1046/j.1365-2796.2003.01096.x

. Retterstol L, Paus B, Bohn M, Bakken A, Erikssen J, Malinow MR, Berg K (University of Oslo; Ullevål University Hospital, Oslo; Akershus University Hospital, Norway; and Oregon Regional Primate Research Center Beaverton, OR, USA). Plasma total homocysteine levels and prognosis in patients with previous premature myocardial infarction: a 10‐year follow‐up study. J Intern Med 2003; 253: 284–292. Objectives.  To explore plasma total homocysteine (tHcy) as a predictor of long‐term prognosis after premature myocardial infarction (MI). Design.  Prospective cohort study. Settings.  Akershus University Hospital. Subjects.  A total of 247 patients (193 men and 54 women) in stable clinical phase after premature MI (males: first MI at age ≤55; females ≤60). Main outcome measures.  The primary end‐point was total mortality and the secondary end‐point was cardiac death. The third end‐point was major cardiac events: a combination of cardiac death, MI and cardiac arrest. Results.  After 10 years, 44 patients had died, 36 from cardiac causes. Major cardiac event occurred in 70 patients. The relative risk for death of all causes increased 1.43 (95% CI, 1.08–1.88) per tHcy quartile (P for trend = 0.01), and was only modestly reduced after adjustment for age, ejection fraction, total cholesterol, C‐reactive protein, fibrinogen, smoking and hypertension to 1.37 (95% CI, 1.04–1.80) (P for trend = 0.03). Similar results were observed when cardiac death was used as the end‐point, but we observed no association between tHcy and the end‐point major cardiac event. Conclusions.  Total homocysteine was an independent predictor of total and cardiac mortality in stable patients following premature MI. tHcy had no effect on major cardiac event in contrast to most other risk factors in this study. Thus, the mechanism(s) underlying the effects of homocysteine on coronary heart disease may differ from other risk factors.