EFFECTS OF AGE, LIPOPROTEINS, AND HEMOSTATIC PARAMETERS ON THE ROLE OF HOMOCYST(E)INEMIA AS A CARDIOVASCULAR RISK FACTOR IN MEN

Previous studies have identified moderately elevated plasma concentrat ions of homocyst(e)ine as an independent risk factor for coronary hear t disease (CHD). The atherogenicity of homocyst(e)ine has mostly been attributed to its effects on endothelial cells, platelets, and the hem ostatic system. In this case-control study of 199 male CHD patients an d 156 age-matched control subjects, we analyzed the role of homocyst(e )ine as a cardiovascular risk marker in the context of traditional ris k factors as well as of plasma fibrinogen, plasminogen, and viscosity. Both univariate and multivariate regression analyses revealed that ho mocyst(e)ine levels were significantly correlated with age, fibrinogen , and plasma viscosity in both study groups. Geometric mean homocyst(e )ine levels by univariate analysis were significantly higher in patien ts than in control subjects (8.9 versus 7.8 mu mol/L, P<.001). This di fference remained significant on multiple logistic function analysis a fter being adjusted for body mass index, systolic blood pressure, seru m cholesterol, and high-density lipoprotein cholesterol but not after additional adjustment for fibrinogen. By contrast, geometric mean fibr inogen levels after adjustment for homocyst(e)ine levels were signific antly different between patients and control subjects (296.4 versus 23 0.8 mg/dL, P<.001). Within the group of CHD patients, both fibrinogen and homocyst(e)ine significantly increased in parallel with the number of stenosed coronary vessels. We conclude that hyperhomocyst(e)inemia is an independent coronary risk factor and that its interrelation wit h fibrinogen levels merits further study. (Arterioscler Thromb. 1991;1 4:460 464.)