Associations between hyperhomocysteinemia and the presence and severity of acute coronary syndrome in young adults ≤ 35 years of age

Abstract

Background The prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults. Methods Young patients (18–35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis. Results A total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93–29.68) vs 12.50 (9.71–17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288–6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) (P = 0.041), multi-vessel disease (P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) (P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001). Conclusion HHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.

Homocysteine metabolism as the target for predictive medical approach, disease prevention, prognosis, and treatments tailored to the person

“…HHcy demonstrated a higher sensitivity (93.1%), accuracy (90.0%), and specificity (86.1%) for obstructive CAD compared to nonobstructive CAD [87]. Sun et al (2021) analyzed whether HHcy is associated with acute coronary syndrome (ACS) and the severity of coronary artery stenosis in young Chinese adults. Young ACS subjects showed a greater prevalence of HHcy when compared with non-CAD individuals.…”

“…Young ACS subjects showed a greater prevalence of HHcy when compared with non-CAD individuals. In addition, HHcy in young ACS patients was linked with the severity of coronary artery stenosis, characterized by increased prevalence of multi-vessel disease, reduced value of left ventricular ejection fraction, and ST-segment elevation myocardial infarction (STEMI) [88]. Another study investigated the linkage between vitamin D deficiency and serum Hcy levels with the extent of CAD.…”

Comparison of clinical profiles and associated factors for acute myocardial infarction among young and very young patients with coronary artery disease

“…High levels of homocysteine are not only associated with the severity of vascular disease but are also associated with an increased risk of sudden events, such as MI and stroke [13,14]. A recent study that included 1103 young participants (18-35 years of age) demonstrated that hyperhomocysteinemia was an independent predictor of ACS after adjusting for traditional confounders [15]. Moreover, young ACS patients with hyperhomocysteinemia had an increased prevalence of STEMI, MVD, decreased LVEF and higher Gensini Scores in ACS patients.…”

Combined effect of hyperhomocysteinemia and smoking on the severity of coronary artery disease in young adults ≤ 35 years of age: a hospital-based observational study

“…However, some controversy exists regarding the causal role of Hcy in CAD pathogenesis, since lowering Hcy levels in patients with CAD has not shown any benefit and common genetic variants that influence Hcy levels are not associated with risk of CAD [ 21 , 22 ]. Nevertheless, several observational studies found HHcy, as an important marker, was significantly associated with severe CAD in younger patients [ 6 , 23 ]. In this study, the relationship between concentrations of Hcy and the severity of coronary artery stenosis was also investigated, which showed that serum Hcy levels were positively associated with angiographic severity expressed by Gensini Score ( β 0.302; 95% CI 0.141–0.462; P < 0.001).…”