Homocysteine and the Risk of Cardiovascular Events and All-Cause Death in Elderly Population: A Community-Based Prospective Cohort Study

Zhongying Zhang; Xiang Gu; Xianghua Fang; Zhe Tang; Shaochen Guan; Hongjun Liu; Xiaoguang Wu; Chunxiu Wang; Yan Zhao

doi:10.2147/TCRM.S239496

Homocysteine and the Risk of Cardiovascular Events and All-Cause Death in Elderly Population: A Community-Based Prospective Cohort Study

Ther Clin Risk Manag. 2020 May 22:16:471-481. doi: 10.2147/TCRM.S239496. eCollection 2020.

Authors

Zhongying Zhang¹, Xiang Gu², Xianghua Fang³, Zhe Tang⁴, Shaochen Guan³, Hongjun Liu³, Xiaoguang Wu³, Chunxiu Wang³, Yan Zhao⁵

Affiliations

¹ Geriatric Department, Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
² Medical Affair Department, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
³ Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
⁴ Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
⁵ Education Department, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.

Abstract

Background: The association between homocysteine and cardiovascular diseases (CVD) and all-cause death was inconclusive. A community-based prospective cohort study was carried out in Beijing to evaluate this association in elderly population for more effective clinical prediction and primary prevention of CVD.

Patients and methods: Participants were randomly selected from Beijing, China. Questionnaire survey, physical examinations, and laboratory tests were carried out to collect baseline information and investigate clinical characteristics. Each participant was predetermined to be followed by 5 years. CVD events and death were collected as primary variables. A Cox regression analysis was performed to assess the risk of CVD events, CVD death, and all-cause death contributed by homocysteine as well as some other risk factors.

Results: A total of 1257 participants with an average age of 69.16 years were enrolled in this study. After adjusting for confounders, the hazard ratios (HRs) and 95% confidence intervals of CVD event, CVD death, and all-cause death caused by intermediate-to-severe hyperhomocysteinemia as compared with normal homocysteine levels were 1.68 (95% CI 1.06-2.67), 1.97 (95% CI 0.95-4.29) and 2.02 (95% CI 1.26-3.24), respectively. Intermediate-to-severe hyperhomocysteinemia increased the risks of CVD event (HR 2.07, 95% CI 1.01-4.26) and all-cause death (HR 3.08, 95% CI 1.56-6.07) among male participants. However, the positive association was not statistically significant among female participants (HR 1.59, 95% CI 0.83-3.04 for CVD event and HR 0.90, 95% CI 0.52-6.07 for all-cause death). Every 5μmol/L increment in homocysteine concentration was shown to be associated with a 4% (HR 1.04, 95% CI 1.01-1.07) and 5% (HR 1.05, 95% CI 1.01-1.07) higher risk of CVD events and all-cause death in all participants. There was no significant association between moderate hyperhomocysteinemia and the risk of the CVD events and all-cause death.

Conclusion: Intermediate-to-severe hyperhomocysteinemia was significantly associated with CVD events and all-cause death in elderly population without a history of ischemia or congestive heart failure (CHF). The positive association was pronounced among males.

Keywords: all-cause death; cardiovascular disease; homocysteine; prospective cohort study.

Grants and funding

This study was supported by grants from the Commission of Science and Technology of Beijing (Grant No: D121100004912002), Beijing Natural Science Foundation (Grant No: 7152068) and the project for collaboration between basis and clinic of Capital Medical University (Grant No: 17JL69).