Hajer Gideon R, van der Graaf Yolanda, Olijhoek Jobien K, Verhaar Marianne C, Visseren Frank L J
Department of Internal Medicine, Section of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Heart. 2007 Feb;93(2):216-20. doi: 10.1136/hrt.2006.093971. Epub 2006 Sep 4.
The metabolic syndrome is associated with increased cardiovascular risk. Elevated plasma homocysteine may cause or result from insulin resistance, and may indicate vascular risk or be actively involved in atherogenesis. The aim of the study was to investigate the relationship between homocysteine, the metabolic syndrome and the incidence of cardiovascular events in patients with manifest vascular disease.
A cohort of 2169 patients with manifest vascular disease was followed for a mean period of 2.8 years. Plasma homocysteine was measured at baseline. Metabolic syndrome was defined by NCEP criteria.
Homocysteine levels were higher in metabolic syndrome patients compared to patients without the metabolic syndrome (14.9+/-0.2 v 14.1+/-0.2 micromol/l; p = 0.002) and increased with the presence of its components (from 0 to 5) (12.7 to 15.9 micromol/l; p<0.001). During follow-up, 52 strokes, 67 myocardial infarctions, 5 fatal ruptures of aortic aneurysms and 53 vascular deaths occurred. Patients without the metabolic syndrome and homocysteine levels in the highest tertile had increased risk for events (HR 1.9; 95% CI 1.0 to 3.5) compared to patients without the metabolic syndrome and homocysteine levels in the lowest tertile. The presence of the metabolic syndrome increased the risk (HR 2.2; 95% CI 1.2 to 4.2), but elevated homocysteine levels further increased the risk only marginally (2.5; 95% CI 1.4 to 4.6).
Metabolic syndrome patients have elevated homocysteine levels, but these higher levels are not associated with an increased risk for new cardiovascular events. In contrast, elevated homocysteine levels confer increased risk in patients without the metabolic syndrome.
代谢综合征与心血管风险增加相关。血浆同型半胱氨酸水平升高可能由胰岛素抵抗引起或导致胰岛素抵抗，可能表明血管风险或积极参与动脉粥样硬化形成。本研究的目的是调查同型半胱氨酸、代谢综合征与明显血管疾病患者心血管事件发生率之间的关系。
对2169例明显血管疾病患者进行队列研究，平均随访2.8年。在基线时测量血浆同型半胱氨酸。代谢综合征根据美国国家胆固醇教育计划（NCEP）标准定义。
与无代谢综合征的患者相比，代谢综合征患者的同型半胱氨酸水平更高（14.9±0.2对14.1±0.2微摩尔/升；p = 0.002），且随着其组分数量（从0至5）的增加而升高（12.7至15.9微摩尔/升；p<0.001）。在随访期间，发生了52次中风、67次心肌梗死、5次主动脉瘤致命破裂和53次血管性死亡。与同型半胱氨酸水平处于最低三分位数的无代谢综合征患者相比，同型半胱氨酸水平处于最高三分位数的无代谢综合征患者发生事件的风险增加（风险比1.9；95%置信区间1.0至3.5）。代谢综合征的存在增加了风险（风险比2.2；95%置信区间1.2至4.2），但同型半胱氨酸水平升高仅使风险略有进一步增加（2.5；95%置信区间1.4至4.6）。
代谢综合征患者的同型半胱氨酸水平升高，但这些较高水平与新的心血管事件风险增加无关。相反，同型半胱氨酸水平升高在无代谢综合征的患者中会增加风险。
