Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study
Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study
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DOI：
10.1016/j.thromres.2014.05.025
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发表时间：
2014-08-01
影响因子：
7.5
通讯作者：
De Luca, Giuseppe
中科院分区：
文献类型：
--
作者：
Schaffer, Alon;Verdoia, Monica;De Luca, Giuseppe
背景：冠状动脉疾病（CAD）仍然是发达国家死亡的主要原因。大型研究项目一直致力于识别预防 CAD 的新危险因素，特别关注同型半胱氨酸 (Hcy)，因为已知与血栓形成、氧化应激状态和内皮功能障碍相关。然而，Hcy 与 CAD 之间的关联仍存在争议。因此，本研究的目的是在接受冠状动脉造影的大型连续队列患者中调查 Hcy 与 CAD 患病率和程度的关系。方法：我们的人群由在意大利诺瓦拉 Azienda Ospedaliera“Maggiore della Carita”之间接受冠状动脉造影的总共 3056 名连续患者代表。收集空腹样本用于同型半胱氨酸水平评估。根据 QCA 评估，冠状动脉疾病的定义为至少 1 处血管狭窄 > 50%。 结果：研究人群根据 Hcy 三分位数 (18.2 nmol/ml) 进行划分。高血浆同型半胱氨酸水平与年龄 (p < 0.001)、男性 (p < 0.001)、高血压 (p < 0.001)、肾功能衰竭 (p < 0.001)、CAD 家族史 (p < 0.001)、既往脑血管意外 (p < 0.001)、既往 MI (p = 0.002)、既往 CABG (p =射血分数 (p < 0.001)、较高的基线肌酐 (p < 0.001)、硝酸盐 (p < 0.001)、钙拮抗剂 (p < 0.001)、利尿剂 (p < 0.001)、Ace 抑制剂 (ACE-I) (p = 0.006)、氯吡格雷 (p = 0.05)、血红蛋白 (p = 0.001)、白细胞 (WBC) 计数 (p = 0.008)、总胆固醇 (p = 0.04)、低密度脂蛋白 (LDL) (p = 0.01)。 Hcy 水平与冠状动脉疾病程度之间存在显着关系（71.8% vs 77.8% vs 77.4%，OR[95% CI] = 1.18[1.11-1.252.]，p < 0.001，与严重 CAD 程度之间存在显着关系（23.6% vs 29.5% vs 32.1%，OR [95% CI] = 1.275 [1.209-1.344]，p < 0.001）与 CAD 风险增加显着相关（调整后 OR [95% CI] = 1.087[1.009-1.171]，p = 0.02 和严重 CAD（调整后 OR [95% CI] = 1.07 [1.01-1.16，P = 0.04]）。结果在大多数高危患者亚群中得到了证实。结论：本研究表明，血浆 Hcy 水平高与 CAD 独立相关，当然需要进一步开展大型研究来探索 Hcy 升高患者服用维生素的辅助益处，以预防 CAD 的发生和进展 (C) 2014 Elsevier Ltd。保留所有权利。
Background: Coronary artery disease (CAD) still represents the major cause of mortality in developed countries. Large research programs have been focused on the identification of new risk factors to prevent CAD, with special attention to homocysteine (Hcy), due to the known associated increased thrombogenicity, oxidative stress status and endothelial dysfunction. However, controversy still exists on the association between Hcy and CAD. Therefore, aim of the current study was to investigate the association of Hcy with the prevalence and extent of CAD in a large consecutive cohort of patients undergoing coronary angiography.Methods: Our population is represented by a total of 3056 consecutive patients undergoing coronary angiography between at the Azienda Ospedaliera "Maggiore della Carita", Novara, Italy. Fasting samples were collected for homocysteine levels assessment. Coronary disease was defined for at least 1 vessel stenosis > 50% as evaluated by QCA.Results: Study population was divided according to Hcy tertiles (18.2 nmol/ml). High plasmatic level of homocysteine was related with age (p < 0.001), male gender (p < 0.001), hypertension (p < 0.001) renal failure (p < 0.001), family history of CAD (p < 0.001), previous cerebrovascular accident (p < 0.001), previous MI (p = 0.002), previous CABG (p = 0.003), ejection fraction (p < 0.001), higher baseline creatinine (p < 0.001), in treatment with nitrates (p < 0.001), calcium antagonists (p < 0.001), diuretics (p < 0.001), Ace inhibitors (ACE-I) (p = 0.006), Clopidogrel (p = 0.05), haemoglobin (p = 0.001), white blood cells (WBC) count (p = 0.008), total cholesterol (p = 0.04), Low-Density Lipoproteins (LDL) (p = 0.01). A significant relationship was found between Hcy levels and the extent of coronary artery disease (71.8% vs 77.8% vs 77.4%, OR[95% CI] = 1.18[1.11-1.252.], p < 0.001 and severe CAD (23.6% vs 29.5% vs 32.1%, OR [95% CI] = 1.275 [1.209-1.344], p < 0.001). Elevated Hcy was significantly associated with increased risk of CAD (adjusted OR [95% CI] = 1.087[1.009-1.171], p = 0.02 and severe CAD (adjusted OR [95% CI] = 1.07 [1.01-1.16, P = 0.04]). The results were confirmed in the majority of high risk subsets of patients.Conclusions: This study showed that high levels of plasmatic Hcy are independently associated with CAD. Further large studies are certainly needed to explore the adjunctive benefits from vitamin administration in patients with elevated Hcy to prevent the occurrence and progression of CAD. (C) 2014 Elsevier Ltd. All rights reserved.