CORONARY HEART DISEASE INCIDENCE IN RELATION TO TOTAL HOMOCYSTEINE

我们使用前瞻性病例队列设计来确定 总同型半胱氨酸(THcy)相关因素与 平均3.3年的冠心病(CHD)发病率 对中年男性和女性的混血样本进行跟踪调查。年龄-， 种族和田野中心调整后的冠心病发病率与 女性与tHcy呈正相关(P&lt；0.05)，而男性与tHcy呈正相关，CHD 与血浆叶酸(仅限女性)、血浆呈负相关(P&lt；0.05 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； 吡哆醛最高五分之一与最低五分之一的相对风险 5=-磷酸盐为0.28(95%CI=0.1~0.7)。他们之间没有联系 亚甲基四氢叶酸C677 T突变与冠心病的关系 还原酶基因或带有3个胱硫氨酸合成酶突变 吉恩。我们的前瞻性发现增加了得出的结论的不确定性 主要来自横断面研究表明，tHcy是一种主要的、独立的、 冠心病的致病危险因素。我们的发现更有力地指出 维生素B6提供独立保护的可能性。 需要随机试验，其中一些正在进行中，以更好地 阐明tHcy、B族维生素与心血管疾病的相互关系 疾病。与加州大学亚伦·福尔索姆博士合作资助 明尼苏达州出版物Folsom AR，Nieto FJ，McGoven PG，McGoven PG， 蔡美美，马利诺先生，JH，赫斯，戴维斯行政长官。预期 冠心病发病率与空腹总量关系的研究 同型半胱氨酸、相关遗传多态和维生素B 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.