Jd. Kark et al., Nonfasting plasma total homocysteine level and mortality in middle-aged and elderly men and women in Jerusalem, ANN INT MED, 131(5), 1999, pp. 321
Citations number
43
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: Elevated plasma total homocysteine level has been associated wi
th cardiovascular disease in many studies, mostly in Europe and North Ameri
ca. Data on persons from other areas and on associations with overall morta
lity are sparse.
Objective: To determine the relation of plasma homocysteine level to all-ca
use and cause-specific mortality.
Design: Prospective observational study with 9- to 11-year follow-up.
Setting: A free-living, multiethnic Jewish population in western Jerusalem,
Israel.
Participants: 1788 residents of Jerusalem (808 men and 980 women) who were
at least 50 years of age and were examined between 1985 and 1987 as part of
the Kiryat Yovel Community Health Study.
Measurements: Nonfasting plasma homocysteine level was determined in frozen
stored samples. Deaths during follow-up were identified by linkage with th
e national population registry.
Results: Plasma homocysteine levels exceeded 14 mu mol/L in 28% of men and
20% of women. During the study period, 405 deaths occurred. In multivariate
Cox models that controlled for possible confounders, a nonmonotonic increa
se in mortality hazard ratios was associated with ascending quintile of hom
ocysteine level: 1.0, 1.4, 1.3, 1.5, and 2.0 (P < 0.001 for trend), The rel
ation was similar for cardiovascular and noncardiovascular causes of death
(excluding cancer). The association was weaker when deaths that occurred du
ring the first 5 years of follow-up were excluded; corresponding hazard rat
ios for ascending quintile of homocysteine level were 1.0, 1.0, 1.2, 1.1, a
nd 1.6 (P = 0.063 for trend). Age- and sex-adjusted percentages of deaths "
attributable" to elevated plasma homocysteine level(greater than or equal t
o 14 mu mol/L) were 12.5% (95% CI, 6.7% to 18.8%)for all deaths, 16.0% (CI,
7.2% to 25.6%) for deaths during the first 5 years of follow-up, and 8.3%
(CI, 1.5% to 16.1%) for later deaths.
Conclusions: A mildly to moderately elevated nonfasting plasma homocysteine
level is a substantial risk marker for death from all causes. The associat
ion seems to be stronger during the first 5 years of follow-up.