Homocysteine and Progression of Coronary Artery Disease

Introduction: Progression of stable coronary artery disease (CAD) is highly prevalent, despite pharmacological intervention and lifestyle changes over several cardiovascular risk factors.
Purpose: Identify markers of progression of atherosclerotic disease in patients with stable angina.
Methods: We studied 216 consecutive patients (pts) admitted for elective coronary angiogram. The subgroup of pts with history of CAD (documented by coronary angiogram in the past) who repeated this exam was analyzed. Demographic, clinical and laboratory variables were studied in 2 groups of pts: with progression VS without progression of CAD. Significant CAD was defined as the presence of at least one lesion causing luminal stenosis ≥ 50%, in at least one epicardial vessel. Progression of CAD was defined as the presence of at least one lesion causing stenosis ≥ 50%, in at least one epicardial vessel, non-existent in the previous angiogram.
Results: We analysed 51 pts, 36 males, with a mean age of 59.73±7.78 years old. We observed CAD progression in 36 pts. This group had higher levels of ApoB (92.35 (80.60-115.50) mg/dL VS 73.10 (60.00-97.40) mg/dL,p=0.026), homocysteine (12.65 (10.89-15.47) umol/L VS 9.06 (8.18-10.40)umol/L,p=0.001) and ApoB/A1 ratio (0.74±0.20 VS 0.62±0.13,p=0.046) and lower levels of folate (5.80 (4.50-8.20) ng/mL VS 10.00 (5.45-14.5)ng/mL,p =0.040) comparing to the group that did not show disease progression. Homocysteine was the only independent predictor of CAD progression by multivariate analysis (OR = 1.65, 95% CI 1.040-2.64 p = 0.03).
Conclusions: The results suggest that, in our population, higher levels of serum homocysteine would independently predict the progression of CAD.