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Homocysteine, vitamin status and risk of vascular disease; effects of gender and menopausal status. European COMAC Group.
Eur Heart J 1999; 20(17):1234-44EH

Abstract

BACKGROUND

Elevated plasma total homocysteine (tHcy) is a known risk factor for vascular disease. Gender, age, and circulating levels of folate, vitamins B(6)and B(12)affect tHcy levels. Objectives To study associations of gender and age with levels of plasma tHcy, and to examine the relationships of tHcy and circulating levels of folate, vitamins B(6)and B(12)with risk of vascular disease in men and women (pre- and post-menopausal).

MATERIAL AND METHODS

In a multicentre case-control study in Europe, 750 patients (544 men, 206 women) with documented vascular disease of the coronary, cerebral, or peripheral vessels and 800 control subjects (570 men, 230 women) were enrolled. Plasma tHcy levels (fasting and after methionine loading) and circulating levels of the vitamins were measured. Adjustment for age and centre was carried out for all statistical analyses, with additional adjustment for serum creatinine and vitamins for the tHcy comparisons between the sexes and between cases and controls. Risk analyses included adjustment for creatinine and traditional risk factors. Relationships between age, gender and tHcy were studied among control subjects only.

RESULTS

Fasting tHcy levels were lower in women than in men. Levels of tHcy showed a positive association with age, for both sexes. In the post-menopausal age category, female post-methionine load tHcy levels surpassed levels of men. Elevation of tHcy (defined as >80th percentile of controls) appeared to be at least as strong a risk factor for vascular disease in women as in men, even before the menopause. For post-methionine load tHcy, there was a 40% stronger association with vascular disease in women than in men. In both sexes, but especially in pre-menopausal women, low circulating levels of vitamin B(6)conferred a two- to threefold increased risk of vascular disease, independent of tHcy. In men, but not in women, low (defined as <20th percentile of controls) circulating folate levels were associated with a 50% increased risk of vascular disease.

CONCLUSIONS

Elevation of tHcy appears to be at least as strong a risk for vascular disease in women as men, even before the menopause. Our data indicate that associations of the various tHcy measurements (and the vitamins that determine them), with risks of vascular disease may differ between the sexes. The tHcy-independent relationship of vitamin B(6)with vascular disease indicates that it will be advisable to test the effects of vitamin B(6)in clinical trials.

Authors+Show Affiliations

Division of Human Nutrition and Epidemiology, Wageningen Centre for Food Sciences and Wageningen University, Wageningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10454975

Citation

Verhoef, P, et al. "Homocysteine, Vitamin Status and Risk of Vascular Disease; Effects of Gender and Menopausal Status. European COMAC Group." European Heart Journal, vol. 20, no. 17, 1999, pp. 1234-44.
Verhoef P, Meleady R, Daly LE, et al. Homocysteine, vitamin status and risk of vascular disease; effects of gender and menopausal status. European COMAC Group. Eur Heart J. 1999;20(17):1234-44.
Verhoef, P., Meleady, R., Daly, L. E., Graham, I. M., Robinson, K., & Boers, G. H. (1999). Homocysteine, vitamin status and risk of vascular disease; effects of gender and menopausal status. European COMAC Group. European Heart Journal, 20(17), pp. 1234-44.
Verhoef P, et al. Homocysteine, Vitamin Status and Risk of Vascular Disease; Effects of Gender and Menopausal Status. European COMAC Group. Eur Heart J. 1999;20(17):1234-44. PubMed PMID: 10454975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine, vitamin status and risk of vascular disease; effects of gender and menopausal status. European COMAC Group. AU - Verhoef,P, AU - Meleady,R, AU - Daly,L E, AU - Graham,I M, AU - Robinson,K, AU - Boers,G H, PY - 1999/8/24/pubmed PY - 1999/8/24/medline PY - 1999/8/24/entrez SP - 1234 EP - 44 JF - European heart journal JO - Eur. Heart J. VL - 20 IS - 17 N2 - BACKGROUND: Elevated plasma total homocysteine (tHcy) is a known risk factor for vascular disease. Gender, age, and circulating levels of folate, vitamins B(6)and B(12)affect tHcy levels. Objectives To study associations of gender and age with levels of plasma tHcy, and to examine the relationships of tHcy and circulating levels of folate, vitamins B(6)and B(12)with risk of vascular disease in men and women (pre- and post-menopausal). MATERIAL AND METHODS: In a multicentre case-control study in Europe, 750 patients (544 men, 206 women) with documented vascular disease of the coronary, cerebral, or peripheral vessels and 800 control subjects (570 men, 230 women) were enrolled. Plasma tHcy levels (fasting and after methionine loading) and circulating levels of the vitamins were measured. Adjustment for age and centre was carried out for all statistical analyses, with additional adjustment for serum creatinine and vitamins for the tHcy comparisons between the sexes and between cases and controls. Risk analyses included adjustment for creatinine and traditional risk factors. Relationships between age, gender and tHcy were studied among control subjects only. RESULTS: Fasting tHcy levels were lower in women than in men. Levels of tHcy showed a positive association with age, for both sexes. In the post-menopausal age category, female post-methionine load tHcy levels surpassed levels of men. Elevation of tHcy (defined as >80th percentile of controls) appeared to be at least as strong a risk factor for vascular disease in women as in men, even before the menopause. For post-methionine load tHcy, there was a 40% stronger association with vascular disease in women than in men. In both sexes, but especially in pre-menopausal women, low circulating levels of vitamin B(6)conferred a two- to threefold increased risk of vascular disease, independent of tHcy. In men, but not in women, low (defined as <20th percentile of controls) circulating folate levels were associated with a 50% increased risk of vascular disease. CONCLUSIONS: Elevation of tHcy appears to be at least as strong a risk for vascular disease in women as men, even before the menopause. Our data indicate that associations of the various tHcy measurements (and the vitamins that determine them), with risks of vascular disease may differ between the sexes. The tHcy-independent relationship of vitamin B(6)with vascular disease indicates that it will be advisable to test the effects of vitamin B(6)in clinical trials. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/10454975/Homocysteine_vitamin_status_and_risk_of_vascular_disease L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1053/euhj.1999.1522 DB - PRIME DP - Unbound Medicine ER -