Lab Med Online.  2016 Oct;6(4):221-227. 10.3343/lmo.2016.6.4.221.

Association of Homocysteine Levels with Subclinical Coronary Atherosclerosis in Asymptomatic Subjects

  • 1Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
  • 2Korea Association of Health Promotion, Seoul, Korea.
  • 3Department of Radiology, Korea Association of Health Promotion, Seoul, Korea.


Progression of atherosclerotic plaques is known to be correlated with elevated circulating homocysteine (Hcy). However, whether the level of Hcy is related with coronary atherosclerosis in the subclinical state is unclear. Therefore, we performed this study to investigate the relationship between blood Hcy levels and subclinical atherosclerosis in asymptomatic self-referred subjects.
We retrospectively enrolled 2,968 self-referred asymptomatic subjects (1,374 men, 1,594 women) who had undergone both coronary CT angiography (CCTA) and coronary artery calcium scoring. The relationships between atherosclerosis, Hcy, and other clinical factors were assessed.
Higher levels of Hcy were related with age, male gender, body mass index (BMI), waist circumference, blood pressure, high density lipoprotein (HDL), triglyceride, blood glucose, HbA1c, hsCRP, and coronary artery calcium score (CACS). Coronary plaque was more frequently found in higher Hcy quartile groups (21.3%, 28.8%, 34.4%, and 34.3%, P<0.001). Significant coronary artery stenosis (stenosis>50%) was also more frequent in higher Hcy quartile groups (1.8%, 5.4%, 5.0%, and 6.6%, P<0.001). The factors associated with CACS included age, male gender, levels of HbA1c, Hcy and hsCRP. Logistic regression analysis adjusted for gender and confounding factors showed that the third- and fourth-quartile Hcy groups had higher odds ratios [odd ratio (OR) 3.980 (1.723-9.194), P=0.001, 7.355 (3.291-16.439), P<0.001, respectively] for high CACS (CACS >400) than the first quartile group.
Blood Hcy levels were associated with an increased risk of the presence and extent of subclinical atherosclerosis in asymptomatic subjects.


Homocysteine; Subclinical coronary atherosclerosis; Coronary CT angiography; Coronary artery calcium score (CACS)
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