HOMOCYST(E)INE AND RISK OF CARDIOVASCULAR-DISEASE IN THE MULTIPLE RISK FACTOR INTERVENTION TRIAL

A nested case-control study was undertaken involving men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Serum samples from 712 men, stored for up to 20 years, were analyzed for homocyst(e )ine. Cases involved nonfatal myocardial infarctions (MIs), identified through the active phase of the study, which ended on February 28, 19 82, and deaths due to coronary heart disease (CHD), monitored through 1990. The nonfatal MIs occurred within 7 years of sample collection, w hereas the majority of CHD deaths occurred more than 11 years after sa mple collection. Mean homocyst(e)ine concentrations were in the expect ed range and did not differ significantly between case patients and co ntrol subjects: MI cases, 12.6 mu mol/L; MI controls, 13.1 mu mol/L; C HD death cases, 12.8 mu mol/L; and CHD controls, 12.7 mu mol/L. Odds r atios versus quartile 1 for CHD deaths and MIs combined were as follow s: quartile 2, 1.03; quartile 3, 0.84; and quartile 4, 0.92. Thus, in this prospective study, no association of homocyst(e)ine concentration with heart disease was detected. Homocyst(e)ine levels were weakly as sociated with the acute-phase protein (C-reactive protein). These resu lts are discussed with respect to the suggestion that homocyst(e)ine i s an independent risk factor for heart disease.