From the Departments of Internal Medicine (A.M., A.N., M.N., A.G.),
Biostatistics and Epidemiology (K.A.), Cell Biology (D.W.J.), Cardiology
(K.R.), and Nephrology and Hypertension (V.W.D.), The Cleveland Clinic
Foundation, Cleveland, Ohio. Dr Gupta is currently at the Department of
Cardiology, Sinai Samaritan Medical Center, Milwaukee, Wis.
Correspondence to Killian Robinson, MD, Desk F15, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail robinsk{at}ccsmtp.ccf.org
Background—Retrospective and
case-control studies show that hyperhomocysteinemia is an independent
risk factor for atherosclerosis in patients with
end-stage renal disease. We studied prospectively the association
between total homocysteine and cardiovascular outcomes.
Methods and Results—In all, 167 patients (93 men, 74 women; mean
age, 56.3±14.7 years) were followed for a mean duration of 17.4±6.4
months. Cardiovascular events and causes of mortality
were related to total homocysteine values and other
cardiovascular risk factors. Cox regression
analysis was used to identify the independent predictors for
cardiovascular events and mortality. Fifty-five
patients (33%) developed cardiovascular events and 31
(19%) died, 12 (8%) of cardiovascular causes. Total
plasma homocysteine values ranged between 7.9 and 315.0 µmol/L.
Levels were higher in patients who had cardiovascular
events or died of cardiovascular causes (43.0±48.6
versus 26.9±14.9 µmol/L, P=.02). The relative
risk (RR) for cardiovascular events, including death,
increased 1% per µmol/L increase in total homocysteine
concentration (RR, 1.01; CI, 1.00 to 1.01; P=.01).
Conclusions—These prospective observations confirm that
hyperhomocysteinemia is an independent risk factor for
cardiovascular morbidity and mortality in end-stage
renal disease, with an increased RR of 1% per µmol/L increase
in total homocysteine concentration. Interventional studies are needed
to evaluate the possible effects of modifying this risk factor in these
patients.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Prospective Study of Hyperhomocysteinemia as an Adverse Cardiovascular Risk Factor in End-Stage Renal Disease
Key Words: homocysteine • risk factors • kidney • artherosclerosis • thrombosis
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