Hyperhomocysteinemia is an independent risk factor in young patients with coronary artery disease in southern China

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2 · Y. Huang2 · Y. Hu2 · J. Zhong2 · Z. He2 · W. Li2 · Y. Yang2 · D. Xu1 · S. Wu1 1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 2 Department of Cardiology, The Affiliated Hospital at Shunde (the First People’s

Hospital of Shunde), Southern Medical University, Shunde

Hyperhomocysteinemia is an independent risk factor in young patients with coronary artery disease in southern China Coronary artery disease (CAD) is becoming the leading cause of death worldwide, including in China. CAD usually involves middle- and older-aged people. However, CAD has been reported more frequently in younger patients in recent years [1]. Studies have shown that the risk factors fpr CAD in young patients are different from those of older patients, but controversies still remain. The Framingham risk score (FRS) is a well-known risk scoring system for predicting CAD [2]. However, the FRS underestimates CAD risk in young individuals [3, 4]. Conventional risk factors, such as dyslipidemia, hypertension, diabetes mellitus (DM), and smoking, cannot account for all cases of CAD in younger patients. Therefore, there are other nonconventional risk factors that appear to be related to atherosclerosis in young patients [5]. Homocysteine (Hcy) is an intermediate metabolite of methionine, which has been extensively investigated and proposed as an independent cardiovascular disease (CVD) risk factor [6]. However, clinical trials have not been able to demonstrate a reduction in clinical cardiovascular endpoints after therapeutic reduction of plasma Hcy levels [7, 8, 9], which suggests that further studies are required to clarify the relationship between Hcy and atherosclerosis. This is particularly the case in low folate regions, including China, which has higher Hcy concentrations because of the nonfortification of folate [8]. Only a few studies have assessed whether Hcy levels contribute to the re-

classification of risk beyond the FRS [6, 10], and few studies have investigated the role of Hcy in CAD among young Chinese. The purpose of this study was to assess the correlation of HHcy and premature CAD after adjusting for traditional CAD risk factors and the FRS in southern China.

Methods Subjects In this cross-sectional study, young CAD patients were defined as those aged 55 years or younger with the first manifestation of CAD, according to the definition used in previous studies [1, 11]. The study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the Affiliated Hospital of Shunde, Southern Medical University, and Nanfang Hospital, Southern Medical University. Written informed consent was obtained from all patients and controls. Recruitment was from August 2010 to August 2012. The study comprised 146 young patients diagnosed with CAD by coronary angiography (CAG). A total of 138 agematched individuals with normal CAG or negative findings at coronary ultrafast computed tomography (CT) were enrolled as controls. The reason for performing coronary angiography or CT was because

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