Heart attacks and homocysteine

BMJ 1996;313:1419-1420 (7 December)

Editorials

Heart attacks and homocysteine

Time for a randomised controlled trial of plasma homocysteinereduction

It is now accepted that an elevated plasma concentration ofhomocysteine is a risk factor for atherosclerotic vascular diseaseaffecting the coronary, cerebral, and peripheral arteries.¹Prospective data² ³ ⁴ confirm the findings of casecontrol studies⁵⁶ ⁷ ⁸ and indicate that an elevated plasma homocysteine concentrationprecedes the development of disease and that there is a dose-responseeffect.

A 5 µmol/l increase in plasma homocysteine concentrationhas been estimated to raise the risk of coronary heart diseaseby as much as an increase in serum cholesterol concentrationof 0.5 mmol/l.¹ Data from the European Union concerted actionproject, a case-control study of 750 patients with vasculardisease and 800 controls, indicate that a plasma homocysteineconcentration above 12 µmol/l (the top fifth of the controldistribution) doubles the risk of myocardial infarction andcerebral or peripheral vascular disease in both men and women.⁹Additional . . . [Full text of this article]

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