Plasma total homocysteine levels in postmenopausal women with unstable coronary artery disease

An elevated plasma total homocysteine (tHcy) level is considered a risk fac tor for coronary artery disease (CAD). but the relationship between plasma tHcy and well-defined CAD in women is still unclear. Plasma tHcy concentrat ions and the covariates serum folate, Vitamin B12, and creatinine were anal ysed in 157 angiographically examined postmenopausal women with unstable CA D and in 101 healthy controls. At coronary angiography, 16% had normal Vess els and 84% had coronary atherosclerosis. Mean plasma tHcy concentration (m u mol/l, 95% confidence interval) did not differ in patients compared to co ntrols (13.1 (12.3-13.8) vs. 12.5 (11.6-13.5)) or in patients with or witho ut coronary atherosclerosis (13.3 (12.4-14.1) vs. 12.0 (10.8-13.2)). A tren d to an increasing plasma tHcy with increasing degree of coronary atheroscl erosis was attenuated after adjustment for age and the previous mentioned c ovariates. Odds ratio for the risk of coronary artery disease and coronary atherosclerosis in hyperhomocysteinemic patients (greater than or equal to 90th percentile in controls) was approximately 3. However, the confidence i nterval included unity in half of the groups and the significance was there fore difficult to judge. Receiver operating characteristics showed age to b e the only variable with a significant discriminatory ability regarding the presence of coronary atherosclerosis (area 0.77). Mild hyperhomocysteinemi a seems not to be related to the risk of unstable CAD in postmenopausal wom en. The trend towards higher plasma tHcy with increasing degree of coronary atherosclerosis may be a marker of the disease. In future studies adjustme nt for age and the other three covariates should be considered. (C) 2000 El sevier Science Ireland Ltd. All rights reserved.