(Circulation. 1997;96:412-417.)
© 1997 American Heart Association, Inc.
Articles |
Myocardial Infarction in Young Women in Relation to Plasma Total Homocysteine, Folate, and a Common Variant in the Methylenetetrahydrofolate Reductase Gene
From the Cardiovascular Health Research Unit (S.M.S., D.S.S., F.R.R., R.K.B., B.M.P., W.T.L., T.D.K.), Department of Epidemiology (S.M.S., D.S.S., F.R.R., R.K.B., B.M.P., W.T.L., T.D.K., T.E.R.), Department of Medicine (D.S.S., B.M.P., T.D.K.), Department of Health Services (B.M.P., T.D.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; the Division of Pathobiology and Immunology (M.R.M.) and Division of Reproductive Sciences (D.L.H.), Oregon Regional Primate Research Center, Beaverton; the Hemostasis and Thrombosis Research Center (F.R.R., P.H.R.) and Department of Clinical Epidemiology (F.R.R.), University Hospital, Leiden, Netherlands; and the Department of Biostatistics (T.E.R), University of Michigan, Ann Arbor. Dr Reitsma is currently at the Laboratory for Experimental Internal Medicine, Academic Medical Center, Amsterdam, Netherlands.
Correspondence to Stephen M. Schwartz, PhD, Cardiovascular Health Research Unit, 1730 Minor Ave, Suite 1360, Seattle, WA 98101. E-mail stevesch{at}u.washington.edu
Background In a population-based study, we examined the relationship between the risk of myocardial infarction (MI) among young women and plasma total homocysteine (tHCY), folate, vitamin B12, and a common cytosine (C) to thymine (T) polymorphism in the gene for 5,10-methylenetetrahydrofolate reductase (MTHFR).
Methods and Results In-person interviews and
nonfasting blood samples were obtained from 79 women <45 years old
diagnosed with MI and 386 demographically similar control subjects
living in western Washington state between 1991 and 1995. Compared with
control subjects, case patients had higher mean tHCY concentrations
(13.4±5.2 versus 11.1±4.4 µmol/L, P=.0004) and
lower mean folate concentrations (12.4±13.4 versus 16.1±12.2 nmol/L,
P=.018). There was no difference in vitamin B12
concentrations between case patients and control subjects (346.8±188.4
versus 349.7±132.4 pmol/L, P=.90). After adjusting for
cardiovascular risk factors, we found that women with
tHCY 
15.6 µmol/L were at approximately twice the risk of MI as
women with tHCY <10.0 µmol/L (OR, 2.3; 95% CI, 0.94 to 5.64).
Women with folate 8.39 nmol/L had an 
50% lower risk of MI than
women with folate <5.27 nmol/L (OR, 0.54; 95% CI, 0.23 to 1.28).
There was no association with vitamin B12 concentration.
Among control subjects, 12.7% were homozygous for the MTHFR
T677 allele, and these women had higher plasma
tHCY and lower plasma folate than women with other genotypes.
Ten percent of case patients were homozygous for
te T677 allele, and there was no association of homozygosity for T677 with MI risk (OR, 0.90; 95% CI, 0.31 to 2.29).
Conclusions These data support the hypothesis that elevated plasma tHCY and low plasma folate are risk factors for MI among young women. Although homozygosity for MTHFR T677 is related to increased plasma tHCY and low plasma folate, this genetic characteristic is not a risk factor for MI in this population.
Key Words: myocardial infarction • women • genetics • homocysteine • folate
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