1015-72 Elevated Plasma Homocysteine: An Important Independent Risk Factor for Coronary Artery Disease in the Elderly

BackgroundHigh plasma homocysteine (HCY) concentration is an established risk factor for premature vascular disease which can be reduced using vitamin therapy. The role of increased homocysteine as a coronary risk factor in the elderly, however, remains uncertain.MethodsWe studied 228 patients with angiographically documented coronary disease (≥ 70% stenosis in at least one major epicardial vessel). These included 136 patients less than, and 92 greater than 65 years old. Patients were compared to 223 healthy controls 199 (<65) and 24 (> 65). The presence of traditional risk factors including hypertension, smoking, hypercholesterolemia and diabetes mellitus were noted. Total fasting plasma homocysteine was measured in all subjects. A gender-adjusted threshold for a high homocysteine level was defined as the 80th percentile for healthy controls (corresponding to a level of 11.7 μmol/L in women and 13.6 μmo1/L in men).ResultsAge<65Age>65PatientsControlsPatientsControlsHomocysteine12.2±4.0*11.0±3.414.2±4.6*11.9±3.6High HCY(%)33*2050†25Odds Ratios2.0*NA2.9*NAConfidence Interval1.2–3.2NA1.0–8.3NA*p<am vs controls†p<0.03ConclusionsHomocysteine concentrations are elevated in patients with coronary artery disease older than 65 years in age. A high value confers an independent three-fold risk for coronary disease in this patient group. Accordingly, intervention studies designed to reduce plasma homocysteine levels should not exclude the elderly