Correlation of homocysteine with the risk of all-cause mortality in patients with coronary heart disease

Objective This study aimed to confirm the correlation between homocysteine and all-cause mortality in patients with coronary heart disease (CHD) and to provide new clues and theoretical basis for the improvement of poor prognosis and the development of preventive measures in CHD. Methods This single-center retrospective cohort study included 660 patients with CHD. The association between homocysteine and all-cause mortality was assessed using Cox regression analyses, subgroup analyses, sensitivity analyses, receiver operating characteristic curve (ROC), and Kaplan–Meier survival curve. Results During a median follow-up time of 45.7 months, 81 all-cause mortality (12%) occurred. Multivariate Cox regression analysis indicated that homocysteine levels were significantly associated with all-cause mortality after adjusting for common confounding factors. Each unit increase and one standard deviation increase in homocysteine levels were associated with a 1% and 15.1% increase in all-cause mortality risk, respectively (HR: 1.010, 95% CI: 1.001–1.019, P = 0.038; HR: 1.151, 95% CI: 1.007–1.314, P = 0.038). Subgroup analysis showed that the risk of all-cause mortality significantly increased with rising homocysteine levels across multiple subgroups ( P < 0.05). Sensitivity analysis showed that after excluding patients with chronic kidney disease, atrial fibrillation, prior percutaneous coronary intervention, and myocardial infarction, the multivariable Cox regression analysis still confirmed the robust association between higher homocysteine levels and higher risk of all-cause mortality ( P < 0.05). ROC analysis showed that homocysteine had a predictive value for the occurrence of all-cause mortality (AUC: 0.660, 95% CI: 0.595–0.726, P < 0.001). The Kaplan–Meier survival curve showed that the cumulative risk of all-cause mortality significantly differed between homocysteine groups (Log-rank P < 0.001). Conclusion Higher levels of homocysteine are significantly associated with a higher risk of all-cause mortality in patients with CHD. This suggests that homocysteine evaluation should be considered in the risk monitoring and prognosis assessment for CHD.