Arnesen E, Refsum H, Bønaa K H, Ueland P M, Førde O H, Nordrehaug J E
Institute of Community Medicine, University of Tromsø, Norway.
Int J Epidemiol. 1995 Aug;24(4):704-9. doi: 10.1093/ije/24.4.704.
Several studies have observed high plasma levels of homocysteine among patients with coronary heart disease (CHD). The only prospective study was based on US physicians, and concluded that homocysteine was associated with subsequent myocardial infarction (MI). However, the association was limited to those above a threshold level of homocysteine.
We conducted a nested case-control study among the 21,826 subjects, aged 12-61 years, who were surveyed in the municipality of Tromsø, Norway. Among those free from MI at the screening, 123 later developed CHD. Four controls were selected for each case.
Level of homocysteine was higher in cases than in controls (12.7 +/- 4.7 versus 11.3 +/- 3.7 mumol/l (mean +/- SD); P = 0.002). The relative risk for a 4 mumol/l increase in serum homocysteine was 1.41 (95% confidence interval (CI): 1.16-1.71). Adjusting for possible confounders reduced the relative risk to 1.32 (95% CI: 1.05-1.65). There was no threshold level above which serum homocysteine is associated with CHD events.
In the general population serum total homocysteine is an independent risk factor for CHD with no threshold level.
多项研究观察到冠心病（CHD）患者血浆同型半胱氨酸水平较高。唯一一项前瞻性研究以美国医生为对象，得出同型半胱氨酸与随后发生的心肌梗死（MI）有关的结论。然而，这种关联仅限于同型半胱氨酸高于阈值水平的人群。
我们在挪威特罗姆瑟市接受调查的21826名年龄在12至61岁之间的受试者中进行了一项巢式病例对照研究。在筛查时无心肌梗死的人群中，有123人后来患上了冠心病。为每个病例选择4名对照。
病例组的同型半胱氨酸水平高于对照组（12.7±4.7对11.3±3.7μmol/L（均值±标准差）；P = 0.002）。血清同型半胱氨酸每增加4μmol/L的相对风险为1.41（95%置信区间（CI）：1.16 - 1.71）。对可能的混杂因素进行校正后，相对风险降至1.32（95%CI：1.05 - 1.65）。不存在血清同型半胱氨酸与冠心病事件相关的阈值水平。
在一般人群中，血清总同型半胱氨酸是冠心病的独立危险因素，且不存在阈值水平。
