The risk association of plasma total homocysteine with acute myocardial infarction is modified by serum vitamin A. (October 2018)

• Record Type: Journal Article
• Authors: Olsen, Thomas; Vinknes, Kathrine J; Svingen, Gard FT; Pedersen, Eva R; Dhar, Indu; Tell, Grethe S; Blomhoff, Rune; Ueland, Per M; Midttun, Øivind; Refsum, Helga; Nygård, Ottar K
• Is Part Of: European journal of preventive cardiology. Volume 25:Number 15(2018)
• Page Start: 1612
• Page End: 1620
• Publication Date: 2018-10
• Subjects: Homocysteine -- vitamin A -- cardiovascular disease; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1177/2047487318788587
• Languages: English
• ISSNs: 2047-4873

Abstract

Background: Plasma total homocysteine (tHcy) has been implicated in the development of cardiovascular disease, but the mechanisms remain unclear. Vitamin A (Vit-A) is involved in homocysteine metabolism and we therefore explored the potential interaction between plasma tHcy and serum Vit-A in relation to incident acute myocardial infarction. Methods: Cox proportional hazards models were used to assess the prospective relationships between tHcy and acute myocardial infarction in 2205 patients from Western Norway undergoing elective coronary angiography for suspected stable angina pectoris. Results are reported as hazard ratio per standard deviation increase in log-transformed tHcy. An interaction term for tHcy × Vit-A was added to multivariate models including age, sex, smoking, apolipoprotein B fasting, statin and aspirin prescription and estimated glomerular filtration rate. Results: Geometric mean (geometric standard deviation) age of the participants (64.3% men) was 62.3 (1.24) years. Plasma tHcy was higher among participants in the upper versus lower Vit-A tertile. During 7 (2.4) years of follow-up, 15.1% suffered an AMI. A significant association of plasma tHcy with AMI in the total study population was observed. When we stratified the population according to Vit-A tertiles, plasma tHcy was associated with acute myocardial infarction only in the upper Vit-A tertile (hazard ratio per SD: 1.25, 95% confidence interval: 1.04–1.53, p interaction = 0.03). Conclusions: The risk relationship between plasma tHcy and acute myocardial infarction was modified by serum concentrations of Vit-A in patients with suspected stable angina pectoris. This finding may clarify the relationship between tHcy and cardiovascular disease.