Department of Clinical Science, KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.
KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.
Am J Clin Nutr. 2019 Jun 1;109(6):1546-1554. doi: 10.1093/ajcn/nqy391.
Elevated circulating cystathionine levels are related to atherosclerotic cardiovascular disease, a leading cause of death globally.
We investigated whether plasma cystathionine was associated with mortality in patients with suspected or established coronary heart disease (CHD).
Data from 2 independent cohorts of patients with suspected stable angina pectoris (SAP) (3033 patients; median 10.7 y follow-up; 648 deaths) or acute myocardial infarction (AMI) (3670 patients; median 7.0 y follow-up; 758 deaths) were included. Hazard ratios with 95% CIs per SD increment of log-transformed cystathionine were calculated using Cox regression modeling. Endpoint data was obtained from a national health registry.
Among patients with SAP, there was a positive association between plasma cystathionine and death (age- and sex-adjusted HRs [95% CI] per SD: 1.23 [1.14, 1.32], 1.29 [1.16, 1.44], and 1.17 [1.05, 1.29] for total, cardiovascular, and noncardiovascular mortality, respectively). Corresponding risk estimates were 1.28 (1.19, 1.37) for all-cause, 1.33 (1.22, 1.45) for cardiovascular, and 1.19 (1.06, 1.34) for noncardiovascular death among AMI patients. In both cohorts, estimates were slightly attenuated after multivariate adjustments for established CHD risk factors. Subgroup analyses showed that the relation between cystathionine and all-cause mortality in SAP patients was stronger among nonsmokers and those with lower plasma concentration of pyridoxal-5'-phosphate (P-interaction ≤ 0.01 for both).
Elevated plasma cystathionine is associated with both cardiovascular and noncardiovascular mortality among patients with suspected or established CHD. The joint risk associations of high plasma cystathionine with lifestyle factors and impaired vitamin B-6 status on mortality need further investigation. This trial was registered at clinicaltrials.gov as NCT00354081 and NCT00266487.
循环胱硫醚水平升高与全球主要致死病因——动脉粥样硬化性心血管疾病相关。
我们旨在探究疑似或确诊冠心病（CHD）患者的血浆胱硫醚水平与死亡率之间的相关性。
纳入了两个独立队列疑似稳定型心绞痛（SAP）（3033 例患者；中位随访 10.7 年；648 例死亡）或急性心肌梗死（AMI）（3670 例患者；中位随访 7.0 年；758 例死亡）患者的数据。使用 Cox 回归模型计算了每标准差对数转换胱硫醚递增的风险比（HR）及其 95%置信区间（CI）。终点数据来源于国家健康登记处。
在 SAP 患者中，血浆胱硫醚与死亡之间存在正相关关系（按年龄和性别校正的 HR[95%CI]：总死亡率、心血管死亡率和非心血管死亡率的每 SD 分别为 1.23[1.14，1.32]、1.29[1.16，1.44]和 1.17[1.05，1.29]）。对于 AMI 患者，全因死亡、心血管死亡和非心血管死亡的相应风险估计值分别为 1.28（1.19，1.37）、1.33（1.22，1.45）和 1.19（1.06，1.34）。在两个队列中，对既定 CHD 风险因素进行多变量校正后，估计值略有减弱。亚组分析表明，在 SAP 患者中，胱硫醚与全因死亡率之间的关系在非吸烟者和血浆吡哆醛-5'-磷酸（PLP）浓度较低的患者中更强（两者的 P 交互作用均≤0.01）。
在疑似或确诊 CHD 的患者中，升高的血浆胱硫醚与心血管和非心血管死亡率均相关。高血浆胱硫醚与生活方式因素以及维生素 B-6 状态受损对死亡率的联合风险关联需要进一步研究。本试验在 clinicaltrials.gov 上注册为 NCT00354081 和 NCT00266487。
