The impact of circulating total homocysteine levels on long-term cardiovascular mortality in patients with acute coronary syndromes

Foussas, Stefanos; Zairis, Michael N.; Makrygiannis, Stamatis S.; Manousakis, Stavros J.; Patsourakos, Nikolaos G.; Adamopoulou, Evdokia N.; Beldekos, Demetrios; Melidonis, Andreas; Handanis, Stylianos M.; Manolis, Athanasios; Hatzisavvas, John J.; Argyrakis, Spyros K.

doi:10.1016/j.ijcard.2007.02.011

Cited by 11 publications

(5 citation statements)

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“…The estimated summary RR (95% CIs) for an increase of 5 mg/l CRP was 1.23 (1.19 to 1.28) (figure 3). Another four12 13 18 20 and three8 17 23 studies reported the risk estimates by each unit of CRP or logarithmically transformed CRP and the pooled RRs (95% CIs) were 1.49 (1.06 to 2.08) per 5 mg/l CRP and 1.26 (0.95 to 1.69) per unit increase of natural logarithmic CRP (mg/l), respectively (figure 4). …”

Section: Resultsmentioning

confidence: 99%

Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies

Tang

Ling

et al. 2010

Heart

134

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Objective To assess the overall effects by a meta-analysis. Data sources Electronic searches on PubMed and Ovid Medline from their start to October 2009 were carried out. Objective Cohort studies and secondary analysis of randomised controlled trials reporting the relative risk (RR) of recurrent cardiovascular events or death associated with C-reactive protein (CRP) obtained within 72 h from acute coronary syndromes (ACS) onset. Data extraction Two epidemiologists independently abstracted information on study design, study and participant characteristics, level of CRP, outcomes, control for potential confounding factors and risk estimates using a standardised form. Results A general variance-based method was used to pool the estimates of risk. Thirteen studies containing 1364 new cases identified from 9787 patients during the followup periods reported the risk estimates by CRP categories. Compared with the bottom CRP category (#3 mg/l), the pooled RRs and their 95% CIs were 1.40 (1.18 to 1.67) for the middle (3.1w10 mg/l) category and 2.18 (1.77 to 2.68) for the top (>10 mg/l) category of CRP values with a random-effects model, respectively. Another four and three studies reported the risk by unit of CRP or logarithmically transformed CRP. The pooled RRs (95% CI) were 1.49 (1.06 to 2.08) per 5 mg/l and 1.26 (0.95 to 1.69) per natural logarithm of CRP (mg/l), respectively. Conclusions Greater early blood CRP moderately increases long-term risk of recurrent cardiovascular events or death, and may be a valuable prognostic predictor in patients after ACS.Atherosclerosis is an inflammatory disease. 1Inflammation has a pivotal role in plaque destabilisation, which results in acute coronary artery syndrome.2 There is intense interest in the relationship between inflammation and cardiovascular diseases, especially acute cardiovascular events. Of all the inflammatory markers for cardiovascular diseases, C-reactive protein (CRP) is considered to be one of the most important markers and has been extensively studied in recent years. A meta-analysis of prospective studies of general populations reported that a higher CRP level was related to a 58% increase in the incidence of cardiovascular diseases, 3 which indicated that CRP was a moderately valuable marker in predicting the development of cardiovascular diseases.The use of CRP for prognosis is believed to be of value. Centers for Disease Control and Prevention (CDC) of America and the American Heart Association (AHA) 4 recommended that CRP should be measured in patients with acute coronary syndromes (ACS) as an independent marker of prognosis. A large number of studies have examined the prognostic value of CRP in patients with acute cardiovascular events at baseline.5e24 Although most of them found a dose-dependent positive association between CRP and late adverse outcomes, the strength of the association varied with each study owing to different settings, populations and outcomes, etc. There is an increasing need to synthesise all the evidence. This meta-analysis...

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Section: Resultsmentioning

confidence: 99%

Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies

Tang

Ling

et al. 2010

Heart

134

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“…These findings are fully in accordance with recent data from the literature. 25 NTproBNP was also strongly associated with mortality by univariate analysis (HR [95% CI]: 3.61 [2.25 to 5.79]). However, because of the small size of the study population and its interaction with some components of the GRACE risk score, ie, age, serum creatinine, heart failure, and hemodynamic parameters, NTproBNP only trend to be associated with the outcome in multivariate analysis (Pϭ0.080).…”

Section: Adma and Mortalitymentioning

confidence: 99%

Impact of Asymmetric Dimethylarginine on Mortality After Acute Myocardial Infarction

Zeller

Korandji

Guilland

et al. 2008

ATVB

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Objective-Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis. Methods and Results-Blood samples from 249 consecutive patients hospitalized for acute MI Ͻ24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA (R 2 ϭ0. 25). Baseline ADMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (1.23 [0.98 Key Words: ADMA Ⅲ myocardial infarction Ⅲ prognosis E ndothelium-derived nitric oxide (NO) plays a pivotal role in coronary vessel homeostasis. In diseased states, such as acute myocardial infarction (MI), endothelial dysfunction linked to reduced NO bioavailability contributes to increased vasoconstrictor responses, adhesion of platelets and monocytes, and proliferation of vascular smooth muscle cells. 1 After an acute coronary event, a high frequency of transient endothelial vasomotor dysfunction has been reported in coronary arteries and in peripheral circulation. 2,3 Impaired endothelial vasodilatation is strongly associated with future cardiovascular (CV) events after an acute coronary syndrome. 4 Over the last decade, several studies have suggested that circulating concentrations of asymmetrical dimethylarginine (ADMA) may provide a marker of risk for atherosclerosis. 5 ADMA is an endogenous competitive inhibitor of all isoforms of NO synthases and may compete with L-arginine as the substrate for the enzyme. ADMA originates from the degradation of posttranslationally methylated proteins in the course of protein turnover. A minor part of circulating ADMA is excreted via renal elimination. The major catabolic pathway of circulating ADMA occurs via dimethylarginine dimethylarginohydrolase (DDAH), which is also thought to play a major role in impaired vascular homeostasis. 6 An association between high ADMA levels and a risk of acute coronary events has been demonstrated in middle-aged men. 7 In patients with documented coronary artery disease, baseline serum concentrations of ADMA independently predict CV events at 2 years follow-up. 8 Only few data are available on levels of ADMA during acute MI. 9 Moreover, there is currently no evidence indicating any prognostic impact of this factor in the setting of acute MI, in particular in comparison with traditional risk factors and biomarkers such as C-reactive protein (CRP) and N-terminal Pro-Brain Natriuretic Peptide (NT-proBNP).From a prospective cohort of patients with acute MI, the aim of the present study was to identify the determinants of ADMA levels and to analyze the predictive value of ADMA on mortality at long-term follow-up. MethodsFor detailed descriptions of the methods, please see sup...

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“…[14,15] Omland et al [16] firstly investigated the possible prognostic value of HCY on survival in 579 patients with acute coronary syndrome after a median follow-up of 628 days. While Foussas et al [17] suggested HCY levels on admission were not an independent predictor of long-term mortality in patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

Jin

Wang

et al. 2019

Chinese Medical Journal

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Background: The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs . those older than 60 years). Statistical analyses were mainly conducted by Student t -test, Chi-squared test, logistic regression, and Cox proportional-hazards regression. Results: The H-HCY group had more males (84.6% vs . 75.4%, P = 0.018), and a lower prevalence of diabetes (20.2% vs . 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs . 4.8%, P = 0.440). During the median follow-up period of 35.8 (26.9–46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) ( P = 0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178–3.005, P = 0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419–2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987–1.027, P = 0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011–1.062, P = 0.005). Conclusion: Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.

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The impact of circulating total homocysteine levels on long-term cardiovascular mortality in patients with acute coronary syndromes

Cited by 11 publications

References 11 publications

Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies

Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies

Impact of Asymmetric Dimethylarginine on Mortality After Acute Myocardial Infarction

Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

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