Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins: The atherosclerosis risk in communities (ARIC) study

Aaron R. Folsom, F. Javier Nieto, Paul G. McGovern, Michael Y. Tsai, M. René Malinow, John H. Eckfeldt, David L. Hess, C. E. Davis

    Research output: Contribution to journalArticle

    571 Scopus citations

    Abstract

    Background - Elevated plasma total homocysteine (tHcy), low B-vitamin intake, and genetic polymorphisms related to tHcy metabolism may play roles in coronary heart disease (CHD). More prospective studies are needed. Methods and Results - We used a prospective case-cohort design to determine whether tHcy-related factors are associated with incidence of CHD over an average of 3.3 years of follow-up in a biracial sample of middle-aged men and women. Age-, race-, and field center-adjusted CHD incidence was associated positively (P<0.05) with tHcy in women but not men, and CHD was associated negatively (P<0.05) with plasma folate (women only), plasma pyridoxal 5'- phosphate (both sexes), and vitamin supplementation (women only). However, after accounting for other risk factors, only plasma pyridoxal 5'-phosphate was associated with CHD incidence; the relative risk for the highest versus lowest quintile of pyridoxal 5'-phosphate was 0.28 (95% CI=0.1 to 0.7). There was no association of CHD with the C677T mutation of the methylenetetrahydrofolate reductase gene or with 3 mutations of the cystathionine β-synthase gene. Conclusions - Our prospective findings add uncertainty to conclusions derived mostly from cross-sectional studies that tHcy is a major, independent, causative risk factor for CHD. Our findings point more strongly to the possibility that vitamin B6 offers independent protection. Randomized trials, some of which are under way, are needed to better clarify the interrelationships of tHcy, B vitamins, and cardiovascular disease.

    Original languageEnglish (US)
    Pages (from-to)204-210
    Number of pages7
    JournalCirculation
    Volume98
    Issue number3
    DOIs
    StatePublished - Jul 21 1998

    Keywords

    • Coronary disease
    • Homocysteine
    • Polymorphism (genetics)
    • Vitamins

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

    Fingerprint Dive into the research topics of 'Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins: The atherosclerosis risk in communities (ARIC) study'. Together they form a unique fingerprint.

  • Cite this