Homocysteine and short-term risk of myocardial infarction and stroke in the elderly - The Rotterdam study

Background: Elevated homocysteine level increases vascular disease risk. Mo st data are based on subjects younger than 60 years; data for the elderly a re more limited. We examined the relationship of homocysteine level to inci dent myocardial infarction and stroke among older subjects in a nested case -control study. Methods: Subjects were participants in the Rotterdam Study, a cohort study among 7983 subjects residing in the Ommoord district of Rotterdam, the Neth erlands. Baseline examinations were performed from March 1, 1990, to July 3 1, 1993. The analysis is restricted to myocardial infarction and stroke tha t occurred before December 31, 1994. One hundred four patients with a myoca rdial infarction and 120 with a stroke were identified with complete data. Control subjects consisted of a sample of 533 subjects drawn from the study base, free of myocardial infarction and stroke. Nonfasting total homocyste ine levels were measured. Results: Results were adjusted for age and sex. The risk of stroke and myoc ardial infarction increased directly with total homocysteine. The linear co efficient suggested a risk increase by 6% to 7% for every 1-mu mol/L increa se in total homocysteine. The risk by quintiles of total homocysteine level was significantly increased only in the group with levels above 18.6 mu mo l/L (upper quintile): odds ratios were 2.43 (95% confidence interval, 1.11- 5.35) for myocardial infarction and 2.53 (95% confidence interval, 1.19-5.3 5) for stroke. Associations were more pronounced among those with hypertens ion. Conclusions: The present study, based on a relatively short follow-up perio d, provides evidence that among elderly subjects an elevated homocysteine l evel is associated with an increased risk of cardiovascular disease.