Relationship between homocysteine and chronic total coronary occlusion: a cross-sectional study from southwest China.

BACKGROUND: Chronic total coronary occlusion is among the most complex coronary artery diseases. Elevated homocysteine is a risk factor for coronary artery diseases. However, few studies have assessed the relationship between homocysteine and chronic total coronary occlusion. METHODS: 1295 individuals from Southwest China were enrolled in the study. Chronic total coronary occlusion was defined as complete occlusion of coronary artery for more than three months. Homocysteine was divided into quartiles according to its level. Univariate and multivariate logistic regression models, receiver operating characteristic curves, and subgroup analysis were applied to assess the relationship between homocysteine and chronic total coronary occlusion. RESULTS: Subjects in the higher homocysteine quartile had a higher rate of chronic total coronary occlusion (P < 0.001). After adjustment, the odds ratio for chronic total coronary occlusion in the highest quartile of homocysteine compared with the lowest was 1.918 (95% confidence interval 1.237-2.972). Homocysteine ≥ 15.2 µmol/L was considered an independent indicator of chronic total coronary occlusion (odds ratio 1.53, 95% confidence interval 1.05-2.23; P = 0.0265). The area under the receiver operating characteristic curve was 0.659 (95% confidence interval, 0.618-0.701; P < 0.001). Stronger associations were observed in elderly and in those with hypertension and diabetes. CONCLUSIONS: Elevated homocysteine is significantly associated with chronic total coronary occlusion, particularly in elderly and those with hypertension and diabetes.

H-type hypertension is a risk factor for chronic total coronary artery occlusion: a cross-sectional study from southwest China.

BACKGROUND: Chronic total coronary occlusion (CTO) is serious and the "last bastion" of percutaneous coronary intervention. Hypertension and hyperhomocysteinemia (HHCY) are synergistic and significantly increase cardiovascular event risk. The relationship between H-type hypertension and CTO remains unclear; thus, this cross-sectional study investigated this potential association. METHODS: Between January 2018 and June 2022, 1446 individuals from southwest China were recruited to participate in this study. CTO was defined as complete coronary artery occlusion persisting for over three months. H-type hypertension was defined as hypertension with plasma homocysteine levels ≥ 15 µmol/L. Multivariate logistic regression models were applied to assess the association between H-type hypertension and CTO. Receiver operating characteristic (ROC) curves were generated to determine the accuracy of H-type hypertension in predicting CTO. RESULTS: Of the 1446 individuals, 397 had CTO, and 545 had H-type hypertension. After multivariate adjustment, the odds ratio (OR) for CTO in individuals with H-type hypertension was 2.3-fold higher (95% CI 1.01-5.26) than that in healthy controls. The risk of CTO is higher in individuals with H-type hypertension than in those with isolated HHCY and hypertension. The area under the ROC curve for CTO was 0.685 (95% CI, 0.653-0.717) for H-type hypertension. CONCLUSIONS: In southwest China, H-type hypertension is significantly related to the occurrence of CTO. TRIAL REGISTRATION: This retrospective study was registered with the Chinese Clinical Trials Registry ( http://www.chictr.org.cn , ChiCTR2100050519.2.2).

The relationship between hyperhomocysteinemia and total coronary artery occlusion: a cross-sectional study from Southwest China.

BACKGROUND: Increasing evidence points to hyperhomocysteinemia as an independent risk factor for coronary artery disease in addition to traditional cardiovascular risks, but few have studied the association between hyperhomocysteinemia and total coronary artery occlusion (TCAO). To understand the risk factors for TCAO, we investigated the potential relationship between hyperhomocysteinemia and TCAO, and the interactions between cardiovascular risk factors and hyperhomocysteinemia. METHODS: A total of 890 adult patients from Southwest China participated in this cross-sectional study between February 2018 and February 2021. TCAO was defined as complete occlusion of more than one of the 15 coronary segments. Hyperhomocysteinemia was defined as serum homocysteine levels ≥15 µmol/L. Multivariable logistic regression models were used to determine the relationship between hyperhomocysteinemia and TCAO. The relationship between homocysteine as a continuous variable and TCAO was also analyzed. Subgroup analyses by sex, age, weight, smoking, hypertension, diabetes, and dyslipidemia were done, and interactions between subgroup variables and hyperhomocysteinemia were performed. RESULTS: Individuals with hyperhomocysteinemia showed an increased risk for TCAO. The adjusted odds ratio for TCAO in individuals with hyperhomocysteinemia was 1.74 (95% confidence interval, 1.28-2.36). When analyzed as a continuous variable, homocysteine was associated with an increased risk for TCAO. Subgroup analysis showed that the association between hyperhomocysteinemia and TCAO was statistically significant in men, elderly, overweight, smokers, and non-diabetic people. Interaction analysis showed no significant interactions between hyperhomocysteinemia and group variables. CONCLUSIONS: In Southwest China, hyperhomocysteinemia was significantly associated with TCAO. This association was particularly significant in men, elderly, overweight, smokers, and non-diabetic people.