Abstract
The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.
Highlights
The cardiovascular diseases (CVDs) are the leading public health challenge having maximum share of the morbidity and mortality worldwide (Feigin et al, 2016; Prabhakaran et al, 2018)
Analysis of the socio-economic status of the study population showed that majority of the cases 66.7% and their control subjects (67.6%) belonged to middle income group followed by low income group which was 22.9% and 20.0% in these groups respectively
Family history of Coronary Heart Disease (CHD) revealed that 14 (13.3%) controls and 28 (26.7%) cases reported that they had family history of CHD whereas 91 (86.7%) controls and 77 (73.3%) cases did not (p=0.016) indicat that family history is a risk factor of CHD
Summary
The cardiovascular diseases (CVDs) are the leading public health challenge having maximum share of the morbidity and mortality worldwide (Feigin et al, 2016; Prabhakaran et al, 2018). The raised plasma homocysteine level above 15 micromoles per liter (mcmol/L) is called hyperhomocysteinemia which promotes thrombosis and acts as a contributory factor for the adverse coronary events (Ranjith and Devika, 2017). Many studies have been conducted on the role of homocysteine (Hcy) as an independent risk factor for CHD. Elevated concentration of plasma homocysteine is linked with risk of myocardial infarction (MI) independent of other risk factors for CHD (Stampfer et al, 1992). Hcy studies collaboration research demonstrated that increase of about 3μmol/L in plasma Hcy will increase 10% risk of cardiovascular events (Homocysteine Studies Collaboration, 2002). Some 10-20% patients of CHD have been associated to increase level of plasma Hcy concentration. Dietary as well as hereditary factors may take part (Herrmann et al, 2006)
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