Circulation. 1998;97:421-424
(Circulation. 1998;97:421-424.)
© 1998 American Heart Association, Inc.
Preventing Coronary Heart Disease
B Vitamins and Homocysteine
Gilbert S. Omenn, MD, PhD;
Shirley A. A. Beresford, PhD;
; Arno G. Motulsky, MD
From the School of Public Health and Community Medicine (G.S.O.),
Departments of Epidemiology (S.A.A.B.) and of Medicine and Genetics (A.G.M.),
University of Washington, Seattle, Wash.
Key Words: Editorials • heart disease • vitamins • homocysteine
The list of
preventable and reversible risk factors for atherosclerotic
cardiovascular disease continues to grow. Cigarette
smoking, high blood pressure, physical inactivity, elevated
cholesterol, underlying lipoprotein abnormalities,
lipoprotein(a), diabetes, overweight, male gender, and age are
well-established risk factors. During the 1990s, there have been many
reports associating elevated plasma homocysteine levels with
arteriosclerotic cardiovascular
disease and consistent evidence that dietary and supplemental
folic acid can reduce homocysteine
levels.1 2
The article by Robinson and colleagues3 in
this issue of Circulation presents further evidence of
the importance of homocysteine and suggestive evidence that plasma
folate and plasma pyrixodal-L-phosphate (vitamin B6) are
protective factors. Their study is part of the European Concerted
Action Project,4 which examined 750 patients
younger than age 60 with diagnoses within the previous 12 months of
coronary, cerebrovascular, or peripheral vascular
disease and 800 healthy control subjects. The patient groups were young
(47 years for cases and 44 years for control subjects) and
heterogeneous, with nonfatal clinical events or symptoms of
arteriosclerotic cardiovascular
disease supported by ECG, angiographic, or Doppler evidence; the
study involved 19 centers in nine European countries. Men in the
highest quintile for fasting total homocysteine (tHcy), compared with
the remainder of the population, had an estimated relative risk of 2.2
(95% confidence interval [CI], 1.6 to 2.9), with a striking
dose-response relationship and a more-than-multiplicative interaction
with cigarette smoking and high blood pressure on vascular disease
risk4 ; the corresponding estimated relative risk
for coronary heart disease was similar (2.0; 95% CI 1.6 . . . [Full Text of this Article]
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