Abstract
Background: Prospective data about the association between serum total homocysteine (Hcy) and vascular disease in Asia is limited because few investigations have evaluated the cutpoint of Hcy for predicting the risk of vascular disease and death. Methods and Results: A community-based prospective cohort study of 2,009 participants, who were free from stroke, coronary heart disease (CHD) and cancer at baseline in 1994 were followed up to 2007 (median 11.95 years); there were 114 documented cases of stroke, 95 of CHD and 380 deaths. Cox proportional hazard model was used to examine the association between Hcy and the incidence of stroke, CHD, and all-cause death. The receiver-operating characteristic curve was performed for determining the cutpoint of Hcy in risk prediction. Hcy levels remained significantly associated with cardiovascular events and death in fully adjusted models. Participants with Hcy >9.47 μmol/L (sensitivity 81.1%, specificity 54.3%) had a 2.3-fold risk for cardiovascular events (95% confidence interval (CI), 1.24-4.18, P=0.008), and participants with Hcy >11.84 μmol/L (sensitivity 49.7%, specificity 84.0%) had a 2.4-fold risk for death (95%CI, 1.76-3.32, P<0.0001). Conclusions: Hcy was significantly related to cardiovascular events and all-cause death, with the best cutpoint values as 9.47 and 11.84, respectively. (Circ J 2009; 73: 1423 - 1430)
