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      Coronary Heart Disease: Reducing the Risk : The Scientific Background to Primary and Secondary Prevention of Coronary Heart Disease A Worldwide View

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          Plasma homocysteine levels and mortality in patients with coronary artery disease.

          Elevated plasma homocysteine levels are a risk factor for coronary heart disease, but the prognostic value of homocysteine levels in patients with established coronary artery disease has not been defined. We prospectively investigated the relation between plasma total homocysteine levels and mortality among 587 patients with angiographically confirmed coronary artery disease. At the time of angiography in 1991 or 1992, risk factors for coronary disease, including homocysteine levels, were evaluated. The majority of the patients subsequently underwent coronary-artery bypass grafting (318 patients) or percutaneous transluminal coronary angioplasty (120 patients); the remaining 149 were treated medically. After a median follow-up of 4.6 years, 64 patients (10.9 percent) had died. We found a strong, graded relation between plasma homocysteine levels and overall mortality. After four years, 3.8 percent of patients with homocysteine levels below 9 micromol per liter had died, as compared with 24.7 percent of those with homocysteine levels of 15 micromol per liter or higher. Homocysteine levels were only weakly related to the extent of coronary artery disease but were strongly related to the history with respect to myocardial infarction, the left ventricular ejection fraction, and the serum creatinine level. The relation of homocysteine levels to mortality remained strong after adjustment for these and other potential confounders. In an analysis in which the patients with homocysteine levels below 9 micromol per liter were used as the reference group, the mortality ratios were 1.9 for patients with homocysteine levels of 9.0 to 14.9 micromol per liter, 2.8 for those with levels of 15.0 to 19.9 micromol per liter, and 4.5 for those with levels of 20.0 micromol per liter or higher (P for trend=0.02). When death due to cardiovascular disease (which occurred in 50 patients) was used as the end point in the analysis, the relation between homocysteine levels and mortality was slightly strengthened. Plasma total homocysteine levels are a strong predictor of mortality in patients with angiographically confirmed coronary artery disease.
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            THE DIET AND 15-YEAR DEATH RATE IN THE SEVEN COUNTRIES STUDY

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              Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease

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                Author and article information

                Journal
                Arteriosclerosis, Thrombosis, and Vascular Biology
                Arterioscler Thromb Vasc Biol
                Ovid Technologies (Wolters Kluwer Health)
                1079-5642
                1524-4636
                August 1999
                August 1999
                : 19
                : 8
                : 1819-1824
                Affiliations
                [1 ]From the Institute of Arteriosclerosis Research and Institute of Clinical Chemistry and Laboratory Medicine (G.A., P.C.), University of Münster, Münster, Germany; the Department of Clinical and Experimental Medicine (F.J., M.M.), University of Naples, Naples, Italy; and the University of London (B.L.), London, UK.
                Article
                10.1161/01.ATV.19.8.1819
                © 1999

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