Total plasma homocysteine and cardiovascular risk profile. The Hordaland Homocysteine Study

O. Nygard, S. E. Vollset, H. Refsum, I. Stensvold, A. Tverdal, J. E. Nordrehaug, M. Ueland and G. Kvale
Section for Medical Informatics and Statistics, University of Bergen, Norway.

OBJECTIVE--To estimate the relations between established cardiovascular risk factors and total homocysteine (tHcy) in plasma. DESIGN--Health examination survey by the Norwegian Health Screening Service in 1992 and 1993. SETTING--General community, Hordaland County of Western Norway. PARTICIPANTS--A total of 7591 men and 8585 women, 40 to 67 years of age, with no history of hypertension, diabetes, coronary heart disease, or cerebrovascular disease were included. MAIN OUTCOME MEASURE--Plasma tHcy level. RESULTS--The level of plasma tHcy was higher in men than in women and increased with age. In subjects 40 to 42 years old, geometric means were 10.8 mumol/L for 5918 men and 9.1 mumol/L for 6348 women. At age 65 to 67 years, the corresponding tHcy values were 12.3 mumol/L (1386 men) and 11.0 mumol/L (1932 women). Plasma tHcy level increased markedly with the daily number of cigarettes smoked in all age groups. Its relation to smoking was particularly strong in women. The combined effect of age, sex, and smoking was striking. Heavy-smoking men aged 65 to 67 years had a mean tHcy level 4.8 mumol/L higher than never-smoking women aged 40 to 42 years. Plasma tHcy level also was positively related to total cholesterol level, blood pressure, and heart rate and inversely related to physical activity. The relations were not substantially changed by multivariate adjustment, including intake of vitamin supplements, fruits, and vegetables. CONCLUSIONS--Elevated plasma tHcy level was associated with major components of the cardiovascular risk profile, ie, male sex, old age, smoking, high blood pressure, elevated cholesterol level, and lack of exercise. These findings should influence future studies on the etiology and pathogenesis of cardiovascular disease.

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