Assossiation Between Plasma Homocysteine And Premature Coronary Artery Disease

Objective:This study aimed to investigate the role of plasma homocysteine (Hcy) in young patients(age≤45years) with premature coronary artery disease (PCAD),and to explore the correlation between Hcy level and their coronary lesion features.Methods:The consecutive patients (aged≤45years) with angiographically proven PCAD, which were hospitalised in the second affiliated hospital of zhejiang university from2009.1to2013.12, were enrolled in the study, and age-matched non-CAD individuals were included as the control group. Hyperhomocysteinemia (HHcy) was defined as Hcy>15μmol/L. We collected the Hcy level and clinical datas, then performed statistical analysis on the coronary lesion features and risk factors in PCAD patients and non-CAD patients.Meanwhile, we explore the optimal cur-off value of Hcy to evaluate the severity of coronary artery lesion in patients with PCAD. Results:We enrolled272consecutive patients for PC AD group, and126patients for non-CAD group.Compared with the non-CAD control group, there was significant higher in Hcy Ievel(13.98±7.41vs.11.18±4.29μmol/L, P=0.001)and proportion of HHcy patients(27.9%vs.7.9%, P<0.001). Proportion of male, diabetes mellitus, smoking,drinking, dyslipidemia, LVEF, APO-A1, FBG, Cr, UA, CRP, CK-MB, cTnI were statistically significant difference between two group (P<0.05). The logistic regression results showed that smoking(OR=5.233,95%CI:2.868-9.510, P<0.001), diabetes mellitus(OR=3.715,95%CI:1.283,10.758,P=0.016), dyslipidemia (OR=2.199,95%CI:1.173-4.123, P=0.014), and HHcy (OR=2.796,95%CI:1.194-6.550, P=0.018) were independently correlated with PCAD patients.Among PCAD patients, There was significant (P=0.027) positive linear correlation between Hcy level and Gensini score(βvalue=0.981,95%CI:0.114-1.849,P=0.027). Then ROC curves and Chi-Square analysis showed that12μmol/L may be the optimal upper limit value of Hcy when it was reflected with the severity of coronary lesion in PCAD patients.The Gensini score is significant higher in the Hey>12μmol/L group(65.92±46.01vs.42.64±34.10, P=0.002), with the logistic regression showing that Hcy>12μmol/L was independently correlated with the severity of coronary lesion in PCAD patients(OR=3.064,95%CI:1.504-6.224, P=0.002), which is described by Gensini score.Conclusion:The study suggests that,for the first time,HHcy is an important independent risk factor for PCAD patients(age≤45y);And Hcy>12μmol/L is an independent risk factor for the severity of coronary lesion in PCAD patients, after adjusting for other risk factors,which suggests that Hcy>12μmol/L is a optimal cut-off value in PCAD patients,and detection of blood Hcy has the clinical value on the prevention and treatment of PCAD.