Coronary artery disease: elevated plasma homocysteine levels increased the risk of dying

Clinical bottom line (level 1b)

  1. One in nine patients with proven severe coronary heart disease died within 3 years.
  2. Patients with proven coronary artery disease and elevated plasma homocysteine levels were at increased risk of dying.
Anderson et al: Circulation 2000; 102 : 1227-1232
Expires March 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: university hospital, USA

1412 patients (aged mean 65, 77% male) with severe coronary artery disease (70% or higher stenosis in 1 or more major vessels) on angiography

Excluded if
  • no blood taken for plasma homocysteine
  • died before discharge following angiography


Factors studied:
  • age, sex, diabetes, hypertension, hyperlipidaemia, family history of heart disease, smoking, disease presentation at index hospitalisation, initial treatment, renal failure, lipid levels, CRP
  • plasma homocysteine (upper third)



    Multivariate logisitic regression analysis was used to adjust for confounding factors.

    100% followed for 1 to 5 years; mean 3
    Outcomes studied:
  • death

      The evidence

      outcome time to outcome number of patients/total number %
      (95% CI)      		 NNF
      (95% CI)
      death 1 to 5 years; mean 3 166/1412 12%
      (10% to 13%)      		 9
      (7 to 10)

      prognostic factor for
      death       		time to outcome adjusted RR
      (95% CI)      		 NNF+
      (95% CI)
      plasma homocysteine (upper third) 1 to 5 years; mean 3 1.64
      (1.13 to 2.38)       		16
      (8 to 80)

        • Other prognostic factors independently associated with mortality were
          • increasing age
          • worsening ejection fraction
          • increased CRP
          • diabetes mellitus

      Citation

      1. Anderson JL, Muhlestein JB, Horne BD, et al: plasma homocysteine predicts mortality independently of traditional risk factors and C-reactive protein in patients with angiographically defined coronary artery disease. Circulation 2000; 102 : 1227-1232
      Search Terms: from ACP Journal Club other articles noted
      Contributor: Chris Ball, March 2002
      Reviewer:

      Clinical Question.
      Patient proven coronary artery disease
      Intervention or Exposure elevated plasma homocysteine
      Outcome death
      		•