Abstract
BackgroundThe prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults.MethodsYoung patients (18–35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis.ResultsA total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93–29.68) vs 12.50 (9.71–17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288–6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) (P = 0.041), multi-vessel disease (P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) (P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001).ConclusionHHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.
Highlights
Acute coronary syndrome (ACS) has become a significant public health problem and the leading cause of morbidity and mortality in the entire world as well in China [1]
In an observational study conducted in elderly patients undergoing coronary angiography (CAG), the elevation of homocysteine (HCY) level was closely associated with severity of coronary artery stenosis [6]; still, the impact of HHCY on acute coronary syndrome (ACS) in young adults has not drawn much attention among research community due to the relatively low prevalence of ACS among young adults
The higher prevalence of current smoker status, hypertension, DM, family history of coronary artery disease (CAD), and familial hypercholesterolemia was found in the ACS group compared to the non-CAD group
Summary
Acute coronary syndrome (ACS) has become a significant public health problem and the leading cause of morbidity and mortality in the entire world as well in China [1]. In an observational study conducted in elderly patients undergoing coronary angiography (CAG), the elevation of homocysteine (HCY) level was closely associated with severity of coronary artery stenosis [6]; still, the impact of HHCY on ACS in young adults has not drawn much attention among research community due to the relatively low prevalence of ACS among young adults. Since general HHCY prevalence has increased over the last two decades in China [7], as well as prevalence among young individuals, the aim of the current study was to analyze the association between HHCY and ACS, including the presence and the severity of coronary artery stenosis among young adults who are 35 years of age and younger. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD) It remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults
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