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Articles

Serum Total Homocysteine Concentration Is Related to Self-Reported Heart Attack or Stroke History among Men and Women in the NHANES III^{1 ,2}

Martha Savaria Morris^*, Paul F. Jacques^*, Irwin H. Rosenberg^*, Jacob Selhub^*, Barbara A. Bowman, Elaine W. Gunter^**, Jacqueline D. Wright and Clifford L. Johnson

^* Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111; Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; ^** Division of Environmental Health Laboratory Sciences, Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia 30341; and Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782

³To whom correspondence should be addressed.

High circulating total homocysteine (tHcy) concentration, which is influenced by folate and vitamin B-12 status, is a suspected cause of cardiovascular events. This relation has been investigated in both case-control and prospective studies but has not been evaluated for different sex x age subgroups of the general U.S. population. We used data on adult (i.e., aged 40 y) male (n = 1097) and female (n = 1107) participants in the third National Health and Nutrition Examination Survey, excluding diabetics and those supplemented with estrogen, vitamins or minerals, to evaluate the association between serum tHcy concentration and self-report of heart attack or stroke. After adjustment for age, race-ethnicity, smoking, blood pressure, blood pressure medication, body mass index and serum concentrations of creatinine and cholesterol, past events were reported 2.4 (95% confidence interval 1.0–5.5) times as often by men with tHcy concentration of >12 µmol/L as by men with lower values. The odds ratio for women was 2.6 (95% confidence interval 1.1–6.6) after adjustment for the same factors plus menopausal status. A stronger relation in men aged 60 y compared with older men may help reconcile conflicting results of earlier studies.

KEY WORDS: • homocysteine • myocardial infarction • stroke • survey • humans

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