1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Plasma Homocysteine in Primary Prevention of Coronary Events?

Among patients with low LDL levels, homocysteine tests did not identify subgroups who would benefit from statin therapy.

Elevated serum homocysteine levels correlate with increased cardiovascular risk, but can homocysteine levels be used to identify high-risk patients who might benefit from primary prevention with statin therapy? Investigators analyzed homocysteine levels in more than 5000 adults who were enrolled in a randomized study of lovastatin for primary prevention of cardiovascular events; at baseline, median LDL cholesterol level among participants was 149 mg/dL.

The median baseline homocysteine level was significantly higher among participants who suffered subsequent sudden cardiac death, fatal or nonfatal myocardial infarction, or unstable angina than among those who did not suffer such events (12.1 vs. 10.9 µmol/L). In addition, risk for such events increased in stepwise fashion with each quartile of homocysteine level. Among patients whose LDL and homocysteine levels were higher than study medians, lovastatin recipients had a marked reduction in risk compared with placebo recipients (relative risk, 0.46). However, among patients with low LDL levels, homocysteine tests did not distinguish subgroups in whom lovastatin was particularly helpful.

Comment: These data suggest that homocysteine is another independent predictor of cardiovascular risk, and that patients with both high LDL and high homocysteine levels likely benefit from primary prevention with statins. However, homocysteine was disappointing as a marker for targeting patients with lower LDL levels in whom statin therapy would be beneficial. These findings contrast with recent findings for C-reactive protein: CRP levels helped distinguish patients with significant responses to statin therapy, even in the lower LDL groups.

— Kirsten E. Fleischmann, MD, MPH

Published in Journal Watch General Medicine May 28, 2002

Citation(s):

Ridker PM et al. Plasma homocysteine concentration, statin therapy, and the risk of first acute coronary events. Circulation 2002 Apr 16; 105:1776-9.

• Original article (Subscription may be required)
• Medline abstract (Free)