摘要
Objective: The impact of homocysteine on cardiovascular disease can be more detrimental in women than in men, but it is unknown whether this applies to high-risk women. We therefore investigated the association of hyperhomocysteinemia with coronary artery disease(CAD) and cardiovascular mortality in high-risk women referred for CAD, both in the total population and in the hypertensive and normotensive cohorts. Design: A prospective study cohort. Setting: A tertiary centre. Patients: Inclusion criteria: 262 consecutive Caucasian postmenopausal women referred for coronary angiography. Exclusion criteria: acute myocardial infarction and vitamin supplementation. Main outcome measure(s): We assessed total plasma homocysteine(tHcy), folate levels, and the MTHFR677C→T polymorphism. CAD was defined as a modified Duke Index score greater than 0; hyperhomocysteinemia as tHcy levels of 15 μmol/l or greater. The primary study outcome was cardiovascular mortality at follow-up. Results: Mild/moderate and severe hyperhomocysteinemia was found in 15.1 and 1.6%of women, respectively, without differences between CAD and non-CAD women. By the ATP III criteria, 92.2%of the women were in the highest risk class and 55%had CAD; however, no association of tHcy with the CAD score was found. After a median follow-up of 3.6 years, 23 women(9.1%) had died, 15(6%) of cardiovascular causes. Women with high tHcy levels showed the worst all-cause and cardiovascular death-free survival at Kaplan-Meier and Cox regression analysis. Moreover, in the hypertensive cohort only women with hyperhomocysteinemia showed increased cardiovascular mortality. Conclusion: Hyperhomocysteinemia is common in high-risk women and adversely affects their prognosis, although it is unrelated to the CAD atherosclerotic burden.
Objective: The impact of homocysteine on cardiovascular disease can be more detrimental in women than in men, but it is unknown whether this applies to high-risk women. We therefore investigated the association of hyperhomocysteinemia with coronary artery disease(CAD) and cardiovascular mortality in high-risk women referred for CAD, both in the total population and in the hypertensive and normotensive cohorts. Design: A prospective study cohort. Setting: A tertiary centre. Patients: Inclusion criteria: 262 consecutive Caucasian postmenopausal women referred for coronary angiography. Exclusion criteria: acute myocardial infarction and vitamin supplementation. Main outcome measure(s): We assessed total plasma homocysteine(tHcy), folate levels, and the MTHFR677C→T polymorphism. CAD was defined as a modified Duke Index score greater than 0; hyperhomocysteinemia as tHcy levels of 15 μmol/l or greater. The primary study outcome was cardiovascular mortality at follow-up. Results: Mild/moderate and severe hyperhomocysteinemia was found in 15.1 and 1.6%of women, respectively, without differences between CAD and non-CAD women. By the ATP III criteria, 92.2%of the women were in the highest risk class and 55%had CAD; however, no association of tHcy with the CAD score was found. After a median follow-up of 3.6 years, 23 women(9.1%) had died, 15(6%) of cardiovascular causes. Women with high tHcy levels showed the worst all-cause and cardiovascular death-free survival at Kaplan-Meier and Cox regression analysis. Moreover, in the hypertensive cohort only women with hyperhomocysteinemia showed increased cardiovascular mortality. Conclusion: Hyperhomocysteinemia is common in high-risk women and adversely affects their prognosis, although it is unrelated to the CAD atherosclerotic burden.
