Serum Homocysteine levels are independently associated with mortality in Primary and Secondary Prevention patients derived from a high-risk clinic population.
Background: Elevated total homocysteine levels (tHCY) have been implicated as an independent risk factor for mortality in patients with known and no known CAD. Few data are available that compare tHCY as a predictor of mortality in both groups. Objectives: In an ongoing, high-risk cardiovascular Prevention Clinic we sought to determine whether tHCY showed evidence of short-term mortality independently of traditional risk factors in primary and secondary prevention patients. Methods: Short term mortality (mean follow-up 26 ± 15 months) was assessed in 2441 clinic patients (1103 primary and 1338 secondary prevention). Cox models were used to assess the unadjusted relationships between tHCY (quartiles: < 9.4, 9.5-11.7, 11.8-14.7, >14.7 μmol/L) and survival time with hazard ratios (HR) used to estimate mortality risk. Framingham global risk scores were calculated for each patient in order to adjust for traditional risk factors (age, gender, LDL-C, HDL-C, blood pressure, diabetes and smoking). Results: The mean age of the overall group was 56 ± 12 years, 34% were women and 62 patients died during the follow-up (18 for primary and 44 for secondary prevention). Serum tHCY quartile showed a relationship to mortality for primary and secondary prevention patients (HR 3.02 and 1.69 respectively) with and without adjustment for traditional risk factors and creatinine (⇓Table). Conclusions: Serum homocysteine levels are independently associated with mortality in primary and secondary Prevention patients derived from the same high-risk clinic population.⇓