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Homocysteine and its relationship with folate, vitamin B12 and early onset coronary artery disease

School

School of Public Health

Document Type

Dissertation

Department (new version)

Public Health

Date of Award

1990

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Epidemiologic data and biologic plausibility suggest that homocystein (HCY) may be a risk factor for coronary artery disease (CAD). Plasma HCY and two vitamin cofactors of its metabolism (folate and vitamin B$\sb{12}$) were evaluated for their relationships with early onset CAD in a case-control study of 101 white men aged 50 years or less with angiographically demonstrated CAD and 108 population-based controls. Plasma folate and vitamin B$\sb{12}$ were significantly inversely correlated with HCY in both cases and controls. Creatinine and protein were significantly positively correlated with HCY both in controls and cases. Daily supplementation of multivitamin B evaluated by a standard food frequency questionnaire was correlated with decreased HCY. HCY in the highest quintile was associated with a 3.83-fold increased risk of CAD (95 percent confidence interval: 1.67, 8.77) as compared to men in the lowest quintile. When adjusting for standard CAD risk factors (age, HDL and LDL-cholesterol, smoking, hypertension, diabetes and obesity), the odds ratio (OR) for CAD associated with HCY in the highest compared to the lowest quintile was 2.63 (95 percent confidence interval: 0.88, 7.87). When natural logarithm of HCY was used, an inverse interaction was found between HCY and LDL-cholesterol (p $<$ 0.03). Plasma folate in the lowest quintile (folate $<$ 2.86 ng/ml) was associated with a 2.58 fold increased risk for CAD (95 percent confidence interval: 1.13, 5.86) as compared to the highest quintile (folate $\geq$ 10.87 ng/ml). This effect was apparently mediated through HCY. In univariate analysis, vitamin B$\sb{12}$ was not associated with CAD, but low vitamin B$\sb{12}$ was marginally (p $<$ 0.07) associated with decreased CAD risk after adjusting for standard CAD risk factors and HCY; OR for CAD associated with vitamin B$\sb{12}$ in the lowest as compared to the highest quintile was 0.37 (95 percent confidence interval: 0.13, 1.06). This study provides further evidence that HCY is an independent risk factor for early onset CAD. Reduction in HCY by increase in folate or multivitamin B supplementation may be effective in reducing the CAD risk.

ProQuest Publication Number

Document on ProQuest

ProQuest ID

9113589

ISBN

979-8-208-01243-7

Comments

DrPH

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