Elevated plasma homocysteine: cause or consequence of myocardial infarction?

• Published in: Journal of Internal Medicine
• Main Authors: Hultdin, J., Thøgersen, A. M., Jansson, J.‐H., Nilsson, T. K., Weinehall, L., Hallmans, G.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2004
• Subjects: Northern Sweden
• Online Access: http://dx.doi.org/10.1111/j.1365-2796.2004.01415.x; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fj.1365-2796.2004.01415.x; https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2796.2004.01415.x

Abstract. Objectives. To determine whether a first myocardial infarction leads to increased plasma homocysteine concentrations and whether the association between homocysteine and myocardial infarction was greater at follow‐up compared with baseline. Design. A population‐based, prospective, nested case‐referent study. Setting. Screening took place at the nearest health survey centre in northern Sweden. Subjects. Of more than 36 000 persons screened, 78 developed a first myocardial infarction (average 18 months after sampling). Fifty of these had participated in a follow‐up health survey (average 8½ years between surveys) and were sex‐ and age‐matched with 56 referents. Main outcome measures. Comparison of plasma homocysteine levels in case and referent subjects before and after development of a first myocardial infarction. Results. No statistically significant difference was found between cases and referents regarding homocysteine at baseline or follow‐up. Plasma homocysteine and plasma creatinine increased significantly, and plasma albumin decreased significantly over time. Conditional univariate logistic regression indicated that high homocysteine at follow‐up but not baseline was associated with first myocardial infarction (OR 2.49; 95% CI: 1.03–6.02), but the relation disappeared in multivariate analyses including plasma creatinine and plasma albumin. High plasma creatinine remained associated with first myocardial infarction at both baseline (OR 2.94; 95% CI: 1.05–8.21) and follow‐up (OR 3.38; 95% CI: 1.21–9.48). Conclusion. In this study, first myocardial infarction did not cause increased plasma homocysteine concentration.