The New England Journal of Medicine
e-mail icon  FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |    Advanced Search
Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe
 
Original Article
PreviousPrevious
Volume 337:230-237 July 24, 1997 Number 4
NextNext

Plasma Homocysteine Levels and Mortality in Patients with Coronary Artery Disease
Ottar Nygård, M.D., Jan Erik Nordrehaug, M.D., Helga Refsum, M.D., Per Magne Ueland, M.D., Mikael Farstad, M.D., and Stein Emil Vollset, M.D., Dr.P.H.

 Sign up for free e-toc
 

This Article
-Full Text
- PDF

Commentary
-Letters

Tools and Services
-Add to Personal Archive
-Add to Citation Manager
-Notify a Friend
-E-mail When Cited

More Information
-PubMed Citation
ABSTRACT

Background Elevated plasma homocysteine levels are a risk factor for coronary heart disease, but the prognostic value of homocysteine levels in patients with established coronary artery disease has not been defined.

Methods We prospectively investigated the relation between plasma total homocysteine levels and mortality among 587 patients with angiographically confirmed coronary artery disease. At the time of angiography in 1991 or 1992, risk factors for coronary disease, including homocysteine levels, were evaluated. The majority of the patients subsequently underwent coronary-artery bypass grafting (318 patients) or percutaneous transluminal coronary angioplasty (120 patients); the remaining 149 were treated medically.

Results After a median follow-up of 4.6 years, 64 patients (10.9 percent) had died. We found a strong, graded relation between plasma homocysteine levels and overall mortality. After four years, 3.8 percent of patients with homocysteine levels below 9 µmol per liter had died, as compared with 24.7 percent of those with homocysteine levels of 15 µmol per liter or higher. Homocysteine levels were only weakly related to the extent of coronary artery disease but were strongly related to the history with respect to myocardial infarction, the left ventricular ejection fraction, and the serum creatinine level. The relation of homocysteine levels to mortality remained strong after adjustment for these and other potential confounders. In an analysis in which the patients with homocysteine levels below 9 µmol per liter were used as the reference group, the mortality ratios were 1.9 for patients with homocysteine levels of 9.0 to 14.9 µmol per liter, 2.8 for those with levels of 15.0 to 19.9 µmol per liter, and 4.5 for those with levels of 20.0 µmol per liter or higher (P for trend = 0.02). When death due to cardiovascular disease (which occurred in 50 patients) was used as the end point in the analysis, the relation between homocysteine levels and mortality was slightly strengthened.

Conclusions Plasma total homocysteine levels are a strong predictor of mortality in patients with angiographically confirmed coronary artery disease.


Source Information

From the Division for Medical Statistics, Department of Public Health and Primary Health Care (O.N., S.E.V.), the Department of Pharmacology (H.R., P.M.U.), and the Division of Biochemistry, Department of Clinical Biology (M.F.), University of Bergen; and the Department of Heart Disease, Haukeland University Hospital (O.N., J.E.N.) — all in Bergen, Norway.

Address reprint requests to Dr. Nygård at the Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.

Full Text of this Article


Related Letters:

Plasma Homocysteine Levels and Mortality in Patients with Coronary Artery Disease
Moll S., Farhadi D., von Eckardstein A., Assmann G., Nygård O., Refsum H., Ueland P. M., Farstad M., Vollset S. E., Nordrehaug J. E.
Extract | Full Text  
N Engl J Med 1997; 337:1631-1633, Nov 27, 1997. Correspondence

This article has been cited by other articles:



HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.