Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road, No. 440, Jinan, Shandong, China.
Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
J Health Popul Nutr. 2023 Aug 16;42(1):81. doi: 10.1186/s41043-023-00430-1.
Hyperhomocysteinemia is one of cardiovascular disease risk factors and fasting homocysteine levels are significantly elevated in male compared to female acute coronary syndrome (ACS) patients with normal renal function. However, it is not known the sex related determinants of plasma homocysteine levels in ACS subjects without renal dysfunction.
A total of 165 ACS participants with normal plasma creatinine who underwent coronary angiography were included in the present study. Clinical parameters, homocysteine, fasting glucose and lipid profile, hemoglobin, white blood cell, platelets, creatinine, cystatin C, blood urea nitrogen, uric acid (UA), and albumin were measured. Multivariate linear regression analyses were used to recognize the predictive factors for homocysteine.
The levels of plasma homocysteine were significantly higher in men than in women (P < 0.0001). In males, homocysteine (log10) was positively associated with hypertension (r = 0.569, P < 0.001), creatinine (r = 0.367, P < 0.001) and cystatin C (log10) (r = 0.333, P = 0.001). In females, homocysteine (log10) was positively correlated with age (r = 0.307, P = 0.107), hypertension (r = 0.456, P < 0.001), creatinine (r = 0.341, P = 0.008), cystatin C (log10) (r = 0.429, P = 0.001) and UA (r = 0.569, P < 0.001) whereas was negatively associated with LDL-C (r = - 0.298, P = 0.021) and ApoB (r = - 0.273, P = 0.033). Parameters up to statistical significance in males or females were incorporated into the stepwise linear regression models. In men, hypertension (P < 0.001) and creatinine (P = 0.031) were independently related to homocysteine. Most of the variability of homocysteine levels in males were only determined by hypertension. In women, cystatin C (log10) (P = 0.004) and hypertension (P = 0.005) were independently related to homocysteine (log10). Plasma cystatin C had a higher explanatory value than hypertension in females.
Hypertension and cystatin C could explain most of the sex differences in serum homocysteine levels in ACS subjects with normal serum creatinine. This finding suggested the importance of making different strategies in males and females to manage hyperhomocysteinemia effectively in ACS subjects without renal dysfunction.
高同型半胱氨酸血症是心血管疾病的危险因素之一，与肾功能正常的急性冠状动脉综合征（ACS）女性患者相比，男性 ACS 患者的空腹同型半胱氨酸水平显著升高。然而，在肾功能正常的 ACS 患者中，同型半胱氨酸水平的性别相关决定因素尚不清楚。
本研究共纳入 165 名接受冠状动脉造影检查且血浆肌酐正常的 ACS 患者。测量临床参数、同型半胱氨酸、空腹血糖和血脂谱、血红蛋白、白细胞、血小板、肌酐、胱抑素 C、血尿素氮、尿酸（UA）和白蛋白。采用多元线性回归分析识别同型半胱氨酸的预测因素。
男性患者的血浆同型半胱氨酸水平明显高于女性（P<0.0001）。在男性中，同型半胱氨酸（log10）与高血压（r=0.569，P<0.001）、肌酐（r=0.367，P<0.001）和胱抑素 C（log10）（r=0.333，P=0.001）呈正相关。在女性中，同型半胱氨酸（log10）与年龄（r=0.307，P=0.107）、高血压（r=0.456，P<0.001）、肌酐（r=0.341，P=0.008）、胱抑素 C（log10）（r=0.429，P=0.001）和 UA（r=0.569，P<0.001）呈正相关，与 LDL-C（r=-0.298，P=0.021）和 ApoB（r=-0.273，P=0.033）呈负相关。在男性或女性中具有统计学意义的参数被纳入逐步线性回归模型。在男性中，高血压（P<0.001）和肌酐（P=0.031）与同型半胱氨酸独立相关。男性同型半胱氨酸水平的大部分变异性仅由高血压决定。在女性中，胱抑素 C（log10）（P=0.004）和高血压（P=0.005）与同型半胱氨酸（log10）独立相关。在女性中，胱抑素 C 比高血压对同型半胱氨酸水平的解释性更强。
高血压和胱抑素 C 可以解释 ACS 患者中肾功能正常的患者血清同型半胱氨酸水平的性别差异。这一发现表明，在肾功能正常的 ACS 患者中，男性和女性应采取不同的策略来有效管理高同型半胱氨酸血症。
