Plasma Homocysteine and Risk for Congestive Heart Failure in Adults Without Prior Myocardial Infarction

Abstract

Context Elevated plasma homocysteine levels are associated with increased risk of vascular disease. It is unclear whether elevated homocysteine levels are a risk factor for congestive heart failure (CHF). Objective To study prospectively the association between nonfasting plasma homocysteine and incidence of CHF. Design, Setting, and Participants Community-based prospective cohort study of 2491 adults (mean age 72 years, 1547 women) who participated in the Framingham Heart Study during the 1979-1982 and 1986-1990 examinations and were free of CHF or prior myocardial infarction (recognized or unrecognized) at baseline. Main Outcome Measure Incidence of a first episode of CHF during an 8-year follow-up period. Results During follow-up, 156 subjects (88 women) developed CHF. In multivariable analyses controlling for established risk factors for CHF including the occurrence of myocardial infarction (recognized or unrecognized) during follow-up, plasma homocysteine levels higher than the sex-specific median value were associated with an adjusted hazards ratio for heart failure of 1.93 in women (95% confidence interval, 1.19-3.14) and 1.84 in men (95% confidence interval, 1.06-3.17). The relation of plasma homocysteine levels to CHF risk was more continuous in women than in men. In analyses restricted to participants without any manifestation of coronary heart disease at baseline, the association of plasma homocysteine levels with risk of CHF was maintained in men and women. Conclusions An increased plasma homocysteine level independently predicts risk of the development of CHF in adults without prior myocardial infarction. Additional investigations are warranted to confirm these findings.

Prognostic value of homocysteine and highly sensitive cardiac troponin T in children with acute heart failure

“…Interestingly, our study also showed that there was a highly significant increase in the plasma level of HCY in patients with CHF before treatment, compared with that after treatment as well as with the control group. This is also in agreement with other investigators [6], [17].…”

Homocysteine Levels Are Associated with Increased Risk of Congestive Heart Failure in Patients with and without Coronary Artery Disease

“…Our results further suggest that hyperhomocysteinemia may be an independent risk factor for developing CHF, regardless of the etiology. These findings are consistent with those of a recent study by Vasan et al [31], which reported that elevated HCY levels were associated with an adjusted hazard ratio for heart failure of 1.93 in women and 1.84 in men who did not have prior MI. A gender difference was also found by Vasan et al [31] in which elevated plasma HCY concentration was related positively and strongly to CHF risk in a continuous fashion in women with no history of MI; the risk of CHF doubled at the second quartile, and a 4-fold risk was observed for those with values in the top quartile versus those whose values were in the lowest quartile.…”

Selective Homocysteine Lowering Gene Transfer Improves Infarct Healing, Attenuates Remodelling, and Enhances Diastolic Function after Myocardial Infarction in Mice

“…Fourthly, elevated plasma homocysteine was associated with an increased incidence of congestive heart failure in the Framingham Heart Study [3]. This association remained significant in multivariable analyses controlling for established risk factors for congestive heart failure including the occurrence of myocardial infarction during follow-up [3]. The current experimental animal intervention study supports the hypothesis that epidemiological associations may reflect a causal relationship.…”

“…Thirdly, plasma homocysteine levels correlate with clinical, echocardiographic, and laboratory parameters of the severity of heart failure [4]. Fourthly, elevated plasma homocysteine was associated with an increased incidence of congestive heart failure in the Framingham Heart Study [3]. This association remained significant in multivariable analyses controlling for established risk factors for congestive heart failure including the occurrence of myocardial infarction during follow-up [3].…”