THE DIAGNOSTIC-VALUE OF SERUM HOMOCYSTEINE CONCENTRATION AS A RISK FACTOR FOR CORONARY-ARTERY DISEASE

Hyperhomocysteinemia is now regarded as an established risk factor for coronary artery disease and is present frequently in the general popu lation. However, the diagnostic value of this risk factor relative to others has only occasionally been investigated. We compared the diagno stic value of classic risk factors and of homocysteine in a retrospect ive case-control study in 191 cases with angiographically established coronary artery disease and 231 healthy controls. Life style habits we re assessed by a detailed questionnaire. Laboratory parameters includi ng lipoproteins and blood lipids, homocysteine, folate, and vitamin B1 2 were measured and their diagnostic value compared with each other by use of receiver-operator characteristic analysis. Comparison of the r eceiver-operator characteristic curves revealed that homocysteine sign ificantly discriminated between cases and control subjects. High-densi ty-lipoprotein cholesterol, triglycerides and non-esterified fatty aci ds also had an area under the curve significantly different from 0.5 ( the area under the curve representing no discrimination). Homocysteine was weakly related to folate, vitamin B12, age and serum creatinine c oncentration. We conclude that hyperhomocysteinemia is at least as imp ortant as conventional risk factors for coronary artery disease and th at receiver operator characteristic analysis of homocysteine is suitab le to determine patients at the highest risk for coronary artery disea se. Clinical trials testing the effect of homocysteine lowering by vit amin supplementation in the prevention of coronary artery disease are needed.