Heart 2001;85:153-158 ( February )

Cardiovascular medicine

Homocysteine and coronary heart disease in the Caerphilly cohort: a 10 year follow up U B Fallon^a, Y Ben-Shlomo^a, P Elwood^b, J B Ubbink^c, G Davey Smith^a

^a Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Rd, Bristol BS8 2PR, UK, ^b MRC Epidemiology Unit, Llandough Hospital, Penarth, South Glamorgan CF64 2XW, UK, ^c University of Pretoria, Department of Chemical Pathology, Faculty of Medicine, PO Box 2034, Pretoria 0001, South Africa

Correspondence to: Dr Fallon una.fallon{at}bristol.ac.uk

Accepted 12 September 2000

OBJECTIVEProspective assessment of the risk of coronary heart disease associated with total serum homocyst(e)ine (homocysteine) concentration.
DESIGNNested case-control study.
SETTINGCaerphilly and surrounding villages in south Wales, UK.
PARTICIPANTS2290 men who participated in phase II of the study in 1984. After a mean follow up of 10 years, 312 men developed coronary heart disease and were compared with 1248 randomly selected, age frequency matched controls.
MAIN OUTCOME MEASUREAcute myocardial infarction or death from coronary heart disease.
RESULTSThe geometric mean serum homocysteine concentration was higher in cases (12.2 µmol/l, 95% confidence interval (CI) 11.8 to 12.6 µmol/l) than in controls (11.8 µmol/l, 95% CI 11.3 to 12.5 µmol/l) (p = 0.09). There was a graded increase in the odds ratio of coronary heart disease across quintiles of the homocysteine concentration distribution compared with the first (p = 0.04), which was attenuated when adjusted for confounding variables (p = 0.4). There was a small but non-significant increase in the adjusted odds ratio of coronary heart disease per standard deviation change in the log distribution of homocysteine concentration (OR = 1.07 (95% CI .93 to 1.24), p = 0.34). Comparing the top quintile of the homocysteine concentration with the remaining 80%, the adjusted odds ratio of coronary heart disease was 1.03 (95% CI 0.73 to 1.45) (p = 0.8) and comparing the top 5% with the remaining 95% it was 1.05 (95% CI 0.56 to 1.95) (p = 0.9).
CONCLUSIONSThese findings do not support the hypothesis that a raised homocysteine concentration is a strong independent risk factor for coronary heart disease. Randomised controlled trials of homocysteine lowering treatment such as folic acid are needed before generalising the early positive results of observational studies.


Keywords: homocysteine; coronary heart disease; cohort

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© 2001 by Heart
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eLetters:

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Homocysteine and coronary heart disease

Nicholas Wald

Online, 14 Mar 2001 [Full text]

Homocysteine and coronary heart disease - Authors' reply

Una B Fallon

Online, 14 Mar 2001 [Full text]