Affiliation:
1. Department of Cardiovascular Medicine Mayo Clinic Rochester MN
2. Division of Cardiology National Defense Medical College Tokorozawa Saitama Japan
3. School of Medicine St. George’s University West Indies Grenada
4. Division of Cardiology Department of Internal Medicine Nowon Eulji Medical Center Eulji University Seoul Republic of Korea
5. Division of Nephrology and Hypertension Mayo Clinic Rochester MN
Abstract
Background
Elevated levels of serum homocysteine, via impaired nitric oxide production, and coronary microvascular dysfunction are associated with increased risk of major adverse cardiovascular events. However, whether serum homocysteine levels and coronary microvascular endothelial dysfunction (CMED) are linked remains unknown.
Methods and Results
This study included 1418 patients with chest pain or an abnormal functional stress test and with nonobstructive coronary artery disease (<40% angiographic stenosis), who underwent CMED evaluation with functional angiography and had serum homocysteine levels measured. Patients were classified as having normal microvascular function versus CMED. Patients in the CMED group (n=743; 52%) had higher mean age (52.1±12.2 versus 50.0±12.4 years;
P
<0.0001), higher body mass index (29.1 [25.0–32.8] versus 27.5 [24.2–32.4];
P
=0.001), diabetes mellitus (12.5% versus 9.4%;
P
=0.03), and fewer women (63.5% versus 68.7%;
P
=0.04) compared with patients in the normal microvascular function group. However, they had lower rates of smoking history, and mildly lower low‐density lipoprotein cholesterol levels. Serum homocysteine levels were significantly higher in patients with CMED, and the highest quartile of serum homocysteine level (>9 µmol/L) was an independent predictor of CMED (odds ratio, 1.34 [95% CI, 1.03–1.75];
P
=0.03) after adjustment for age; sex; body mass index; chronic kidney disease (CKD); diabetes mellitus; smoking exposure; low‐density lipoprotein cholesterol; high‐density lipoprotein cholesterol and triglycerides; and aspirin, statin, and B vitamin use.
Conclusions
Patients with CMED have significantly higher levels of serum homocysteine. Elevated serum homocysteine levels were associated with a significantly increased odds of an invasive diagnosis of CMED. The current study supports a potential role for homocysteine for diagnosis and target treatment in the patients with early coronary atherosclerosis.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
26 articles.
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