Coronary Heart Disease
Hyperhomocysteinemia and low pyridoxal phosphate. Common and independent
reversible risk factors for coronary artery disease.
Robinson K; Mayer EL; Miller DP; Green R; van Lente F; Gupta A; Kottke-Marchant
K; Savon SR; Selhub J; Nissen SE; et al
Circulation 1995 Nov 15;92(10):2825-30
BACKGROUND: High plasma homocysteine is associated with premature coronary
artery disease in men, but the threshold concentration defining this risk
and its importance in women and the elderly are unknown. Furthermore,
although low B vitamin status increases homocysteine, the link between
these vitamins and coronary disease is unclear. METHODS AND RESULTS: We
compared 304 patients with coronary disease with 231 control subjects.
Risk factors and concentrations of plasma homocysteine, folate, vitamin
B12, and pyridoxal 5'-phosphate were documented. A homocysteine concentration
of 14 mumol/L conferred an odds ratio of coronary disease of 4.8 (P <
.001), and 5-mumol/L increments across the range of homocysteine conferred
an odds ratio of 2.4 (P < .001). Odds ratios of 3.5 in women and of
2.9 in those 65 years or older were seen (P < .05). Homocysteine
correlated negatively with all vitamins. Low pyridoxal 5'-phosphate
(< 20 nmol/L) was seen in 10% of patients but in only 2% of control
subjects (P < .01), yielding an odds ratio of coronary disease adjusted
for all risk factors, including high homocysteine, of 4.3 (P < .05).
CONCLUSIONS: Within the range currently considered to be normal,
the risk for coronary disease rises with increasing plasma homocysteine
regardless of age and sex, with no threshold effect. In addition to a
link with homocysteine, low pyridoxal-5'-phosphate confers an independent
risk for coronary artery disease.