Key result
High homocysteine levels were independently associated with a 2.28-fold higher likelihood of incident novel carotid plaque compared to lower levels, with the highest risk seen when combined with elevated LDL-C.
Why the study?
The prospective relationship between homocysteine and incident carotid plaque, as well as its additive effect with LDL-C, has not been well established.
Does elevated homocysteine combined with high LDL-C increase the incidence of novel carotid plaque in a Chinese community-based population?
Cohort (n=474)
No
Does elevated homocysteine combined with high LDL-C increase the incidence of novel carotid plaque in a Chinese community-based population?
Odds Ratio: 2.28 (95% CI 1.33–3.93)
Absolute Event Rate: 35.2% vs 19.1%
p-value: p=0.002
Elevated homocysteine levels, particularly when combined with LDL-C ≥ 3.4 mmol/L, significantly increase the risk of novel carotid plaque formation in a Chinese community-based population.
Should not yet change practice or screening; leaves open whether HCY-lowering prevents incident plaque, especially with high LDL-C.
OBJECTIVE: Homocysteine (HCY) has been associated with carotid plaque in cross-sectional studies, but the prospective relationship between HCY and incident carotid plaque has not been well established. The purpose of this study was to investigate the association between HCY and incidence of novel carotid plaque in a Chinese community-based population without pre-existing carotid atherosclerosis and to assess the additive effect of HCY and low-density lipoprotein cholesterol (LDL-C) on the incidence of novel plaque. METHODS: At baseline, we measured HCY and other risk factors in subjects aged ≥ 40 years. All participants underwent carotid ultrasound examinations at baseline and after an average of 6.8 years of follow-up. Incidence of plaque was identified if plaque was absent at baseline, but plaque was detected at the end of follow-up. A total of 474 subjects were included in the analysis. RESULTS: The incidence of novel carotid plaque was 24.47%. Multivariate regression analyses showed that HCY was independently associated with a 1.05-fold-higher likelihood for incident novel plaque (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.01-1.09, P = 0.008). Using tertile 1 and tertile 2 for reference, the top HCY tertile (T3) showed a 2.28-fold-higher likelihood for incident plaque (adjusted OR = 2.28, 95%CI: 1.33-3.93, P = 0.002). The combination of HCY T3 and LDL-C ≥ 3.4 mmol/L had the highest risk for novel plaque formation (adjusted OR = 3.63, 95%CI: 1.67-7.85, P = 0.001) compared to those without either condition. In the LDL-C ≥ 3.4 mmol/L subgroup, HCY was significantly associated with incidence of plaque (adjusted OR = 1.16, 95%CI: 1.04-1.28, P = 0.005, P-interaction = 0.023). CONCLUSION: In the Chinese community-based population, HCY was independently associated with the incidence of novel carotid plaque. There were additive effect between HCY and LDL-C on the incidence of plaque, the highest risk was observed in individuals with both high HCY levels and LDL-C ≥ 3.4 mmol/L. Our findings suggest that HCY may be a potential target for preventing the incidence of carotid plaque, particularly in individuals with elevated LDL-C levels.
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Momin et al. (2023) conducted a cohort in Carotid atherosclerosis (n=474). High homocysteine (top tertile, ≥12.56 μmol/L) vs. Lower homocysteine (tertiles 1 and 2, <12.56 μmol/L) was evaluated on Incidence of novel carotid plaque (OR 2.28, 95% CI 1.33-3.93, p=0.002). High homocysteine levels were independently associated with a 2.28-fold higher likelihood of incident novel carotid plaque compared to lower levels, with the highest risk seen when combined with elevated LDL-C.
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