Department of Cardiology, VIP Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
BMC Cardiovasc Disord. 2021 Jan 23;21(1):47. doi: 10.1186/s12872-021-01869-y.
The prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults.
Young patients (18-35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis.
A total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93-29.68) vs 12.50 (9.71-17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288-6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) (P = 0.041), multi-vessel disease (P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) (P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001).
HHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.
急性冠状动脉综合征（ACS）在年轻的中国成年人中的患病率持续上升。同型半胱氨酸（HCY）已被认为是导致动脉粥样硬化和冠状动脉疾病（CAD）的促进因素。然而，HCY 是否与年轻人的 ACS 和冠状动脉狭窄的严重程度有关仍不确定。
2013 年 1 月至 2019 年 6 月期间在北京安贞医院接受冠状动脉造影（CAG）的诊断为 ACS 的年轻患者（18-35 岁）被分配到 ACS 组。同期通过 CAG 确诊，无 CAD 的年龄匹配人群被分配到非 CAD 组。定义血清 HCY 水平>15μmol/L 为高同型半胱氨酸血症（HHCY）。Gensini 评分评估冠状动脉狭窄的严重程度。
共有 1103 名参与者，包括 828 名 ACS 患者和 275 名非 CAD 患者，纳入本研究。与非 CAD 患者相比，年轻 ACS 患者的血清 HCY 水平更高，且 HHCY 的患病率更高[HCY：16.55（11.93-29.68）比 12.50（9.71-17.42），P<0.001；HHCY 患病率：62.08%比 26.18%，P<0.001]。逐步多变量 logistic 回归分析表明，在校正了传统混杂因素后，HHCY 是与 ACS 存在相关的独立预测因子（OR：4.561；95%CI：3.288-6.327；P<0.001）。此外，患有 HHCY 的年轻 ACS 患者中，ST 段抬高型心肌梗死（STEMI）（P=0.041）、多支血管疾病（P=0.036）的患病率增加，左心室射血分数（LVEF）（P=0.01）降低。此外，ACS 患者的 HCY 水平与 Gensini 评分呈显著相关（r=0.142，P<0.001）。
HHCY 与年轻成年人（≤35 岁）ACS 的发生和冠状动脉狭窄的严重程度显著相关。
