A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians.
A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians.
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DOI：
10.1001/jama.1992.03490070059042
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发表时间：
1992-08
期刊：
影响因子：
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通讯作者：
M. Stampfer;M. Malinow;W. Willett;L. Newcomer;B. Upson;D. Ullmann;P. Tishler;C. Hennekens
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文献类型：
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作者：
M. Stampfer;M. Malinow;W. Willett;L. Newcomer;B. Upson;D. Ullmann;P. Tishler;C. Hennekens
目的前瞻性评估血浆同型半胱氨酸水平升高与冠心病的相关性。设计：前瞻性采集血样，巢式病例对照研究。背景：参与医生健康研究的人员。参与者共有14，916名男性医生，年龄在40至84岁之间，既往无心肌梗死（MI）或卒中，在基线时提供血浆样本，并随访5年。分析了271名随后发生MI的男性样本的同型半胱氨酸水平，并与年龄和吸烟情况相匹配的配对对照进行了分析。主要观察指标急性心肌梗死或冠心病死亡。结果病例组的同型半胱氨酸水平高于对照组（11.1 +/- 4.0 [SD] vs 10.5 +/- 2.8 nmol/mL; P = 0.03）。这一差异是由于后来患有MI的男性中的高值过多。同型半胱氨酸水平最高的5%与最低的90%的相对风险为3.1（95%置信区间，1.4至6.9; P = 0.005）。在对糖尿病、高血压、阿司匹林分配、克托莱指数和总/高密度脂蛋白胆固醇进行额外校正后，该相对风险为3.4（95%置信区间，1.3至8.8）（P = .01）。13例对照和31例病例（11%）的数值高于对照的第95百分位数。结论：中等水平的血浆同型半胱氨酸与随后的MI风险相关，与其他冠状动脉危险因素无关。由于高水平通常可以很容易地用维生素补充剂治疗，同型半胱氨酸可能是一个独立的，可改变的风险因素。
OBJECTIVE To assess prospectively the risk of coronary heart disease associated with elevated plasma levels of homocyst(e)ine. DESIGN Nested case-control study using prospectively collected blood samples. SETTING Participants in the Physicians' Health Study. PARTICIPANTS A total of 14,916 male physicians, aged 40 to 84 years, with no prior myocardial infarction (MI) or stroke provided plasma samples at baseline and were followed up for 5 years. Samples from 271 men who subsequently developed MI were analyzed for homocyst(e)ine levels together with paired controls, matched by age and smoking. MAIN OUTCOME MEASURE Acute MI or death due to coronary disease. RESULTS Levels of homocyst(e)ine were higher in cases than in controls (11.1 +/- 4.0 [SD] vs 10.5 +/- 2.8 nmol/mL; P = .03). The difference was attributable to an excess of high values among men who later had MIs. The relative risk for the highest 5% vs the bottom 90% of homocyst(e)ine levels was 3.1 (95% confidence interval, 1.4 to 6.9; P = .005). After additional adjustment for diabetes, hypertension, aspirin assignment, Quetelet's Index, and total/high-density lipoprotein cholesterol, this relative risk was 3.4 (95% confidence interval, 1.3 to 8.8) (P = .01). Thirteen controls and 31 cases (11%) had values above the 95th percentile of the controls. CONCLUSIONS Moderately high levels of plasma homocyst(e)ine are associated with subsequent risk of MI independent of other coronary risk factors. Because high levels can often be easily treated with vitamin supplements, homocyst(e)ine may be an independent, modifiable risk factor.