Arteriosclerosis, Thrombosis, and Vascular Biology. 1998;18:1895-1901
© 1998 American Heart Association, Inc.
Original Contributions |
Serum Homocysteine and Risk of Coronary Heart Disease and Cerebrovascular Disease in Elderly Men
A 10-Year Follow-Up
From the Institute for Cardiovascular Research, Vrije Universiteit and the Department of Medicine (C.D.A.S.), the Department of Vascular Surgery (M.v.d.B.), and the Department of Clinical Chemistry (C.J.), Academisch Ziekenhuis Vrije Universiteit, Amsterdam; and the Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven (M.P.W., E.J.M.F, D.K.), Netherlands.
Correspondence to Dr C.D.A. Stehouwer, Department of Medicine, Academisch Ziekenhuis Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands. E-mail cda.stehouwer{at}azvu.nl
Abstract—Hyperhomocysteinemia is
an independent risk factor for atherosclerotic disease in the
middle-aged. We investigated whether a high serum homocysteine level is
a risk factor for vascular disease in 878 elderly men (mean age at
baseline, 71.5 years; range, 64 to 84 years) in a population-based,
representative cohort followed up for 10 years in
Zutphen, the Netherlands. Thirty-one percent had nonfasting
homocysteine levels 
17 µmol/L. After adjustment for other
major risk factors, high homocysteine levels at baseline (the third
compared with the first tertile) were associated with an increased
baseline prevalence of myocardial infarction (odds ratio [OR], 1.81;
95% confidence interval [CI], 1.07 to 3.08; P for
trend, 0.03) and with a marginally significant increase in the risk of
dying of coronary heart disease (relative risk [RR], 1.58;
95% CI, 0.93 to 2.69; P for trend, 0.09) but not with
an increased risk of first-ever myocardial infarction. In addition,
high homocysteine levels at baseline were associated with an increased
baseline prevalence of stroke (OR, 4.61; 95% CI, 1.79 to 11.89;
P for trend, 0.002) and with an increased risk of dying
of cerebrovascular disease in subjects without hypertension (RR, 6.18;
95% CI, 2.28 to 16.76) but not in those with hypertension. High
homocysteine levels were associated with an increased risk of
first-ever stroke among normotensive subjects that was not
statistically significant (RR, 1.77 [95% CI, 0.83 to 3.75;
P for trend, 0.14]). In a general population of elderly
men, a high homocysteine level is common and is strongly associated
with the prevalence of coronary heart disease and
cerebrovascular disease. It is a strong predictive factor for fatal
cerebrovascular disease in men without hypertension but less so for
coronary heart disease.
Key Words: homocysteine • atherosclerosis • vascular disease • elderly
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