CORONARY HEART DISEASE INCIDENCE IN RELATION TO TOTAL HOMOCYSTEINE

我们采用前瞻性病例队列设计来确定是否 总同型半胱氨酸（tHcy）相关因素与 平均3.3年的冠心病发病率 对中年男性和女性的双胞胎样本进行随访。 年龄-， 种族和地区中心校正的CHD发病率与 女性与tHcy呈显著正相关（P<0.05），而男性与tHcy无显著正相关（P> 0.05），冠心病与tHcy呈显著正相关（P<0.05），而女性与tHcy呈显著正相关（P<0.05），而男性与tHcy无显著正相关（P> 0.05）。 与血浆叶酸（仅女性）、血浆 吡哆醛5=磷酸盐（两性）和维生素补充剂 （仅限女性）。 然而，在考虑到其他风险因素后，只有 血浆吡哆醛5=-磷酸与冠心病发病率相关; 吡哆醛最高与最低五分位数的相对风险 5=-磷酸盐为0.28（95% CI=0.1 - 0.7）。 无相关性 CHD合并亚甲基四氢叶酸C677 T突变 还原酶基因或三个突变的胱硫醚？合酶 基因 我们的前瞻性发现增加了不确定性的结论， 主要来自横断面研究，表明tHCy是一个主要的、独立的、 冠心病的危险因素。 我们的发现更有力地表明， 维生素B6提供独立保护的可能性。 需要进行随机试验，其中一些正在进行中，以更好地 阐明tHcy、B族维生素和心血管疾病之间的相互关系 疾病 资助与博士亚伦福尔松，大学的合作 明尼苏达州出版物福尔松AR，涅托FJ，麦戈文PG，麦戈文PG， Tsai MY，Malinow MR，Eckfeldt JH，Hess DL，Davis CE. 前瞻性 冠心病发病率与空腹血糖关系的研究 同型半胱氨酸、相关遗传多态性和B族维生素 社区动脉粥样硬化风险（ARIC）研究。 循环 98：204-210，1998.

We used a prospective case-cohort design to determine whether total homocysteine (tHcy)-related factors are associated with incidence of coronary heart disease (CHD) over an average of 3.3 years of follow-up in a biracial sample of middle-aged men and women. Age-, race-, and field center-adjusted CHD incidence was associated positively (P<0.05) with tHcy in women but not men, and CHD was associated negatively (P<0.05) with plasma folate (women only), plasma pyridoxal 5=-phosphate (both sexes), and vitamin supplementation (women only). However, after accounting for other risk factors, only plasma pyridoxal 5=-phosphate was associated with CHD incidence; the relative risk for the highest versus lowest quintile of pyridoxal 5=-phosphate was 0.28 (95% CI=0.1 to 0.7). There was no association of CHD with the C677 T mutation of the methylenetetrahydrofolate reductase gene or with three mutations of the cystathionine ?-synthase gene. Our prospective findings add uncertainty to conclusions derived mostly from cross-sectional studies that tHcy is a major, independent, causative risk factor for CHD. Our findings point more strongly to the possibility that vitamin B6 offers independent protection. Randomized trials, some of which are under way, are needed to better clarify the interrelationships of tHcy, B vitamins, and cardiovascular disease. FUNDING Collaboration with Dr. Aaron Folsom, University of Minnesota PUBLICATIONS Folsom AR, Nieto FJ, McGovern PG, McGovern PG, Tsai MY, Malinow MR, Eckfeldt JH, Hess DL, Davis CE. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 98:204-210, 1998.