Coffee consumption and mortality in Japan with 18 years of follow-up: the Jichi Medical School Cohort Study.

OBJECTIVE: Coffee consumption can be expected to reduce mortality due to cardiovascular diseases and cancer. This study tested the hypothesis of an inverse association between coffee intake and all-cause mortality and mortality due to cancer, coronary heart disease, or stroke. STUDY DESIGN: Prospective cohort study. METHODS: We analyzed data from the Jichi Medical School Cohort Study, Japan, enrolling 9946 subjects (men/women: 3870/6,076, age: 19-93 years) from 12 communities. A food frequency questionnaire assessing the subjects' daily coffee consumption was used. RESULTS: During an average follow-up of 18.4 years, the total number of deaths was 2024, including 677 for cancer, 238 for coronary heart disease, and 244 for stroke. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality and cause-specific mortality due to cancer, coronary heart disease, and stroke. Overall, no significant association was shown between coffee consumption and all-cause mortality. In the cause-specific mortality analyses, stroke mortality was significantly lower in those who consumed 1-2 cups of coffee daily (HR [95% CI]: 0.63 [0.42-0.95]) than in those who do not consume coffee, and this association occurred only in men. CONCLUSION: This study showed no significant association between coffee consumption and all-cause mortality. A U-shaped association between coffee consumption and stroke mortality with a 37% lower stroke mortality, only significant in men who consume 1-2 cups of coffee daily was observed. It is necessary to examine the possibility of intervention studies to reduce stroke mortality through coffee consumption.

Ethnic Differences in Risk of Coronary Heart Disease in a Large Contemporary Population.

INTRODUCTION: Racial/ethnic differences in diabetes and cardiovascular disease are well documented, but disease estimates are often confounded by differences in access to quality health care. The objective of this study was to evaluate the ethnic differences in risk of future coronary heart disease in patient populations stratified by status of diabetes mellitus and prior coronary heart disease among those with uniform access to care in an integrated healthcare delivery system in Northern California. METHODS: A cohort was constructed consisting of 1,344,899 members with self-reported race/ethnicity, aged 30-90 years, and followed from 2002 through 2012. Cox proportional hazard regression models were specified to estimate race/ethnicity-specific hazard ratios for coronary heart disease (with whites as the reference category) separately in four clinical risk categories: (1) no diabetes with no prior coronary heart disease; (2) no diabetes with prior coronary heart disease; (3) diabetes with no prior coronary heart disease; and (4) diabetes with prior coronary heart disease. Analyses were performed in 2015. RESULTS: The median follow-up was 10 years (10,980,800 person-years). Compared with whites, blacks, Latinos, and Asians generally had lower risk of coronary heart disease across all clinical risk categories, with the exception of blacks with prior coronary heart disease and no diabetes having higher risk than whites. Findings were not substantively altered after multivariate adjustments. CONCLUSIONS: Identification of health outcomes in a system with uniform access to care reveals residual racial/ethnic differences and point to opportunities to improve health in specific subgroups and to improve health equity.

Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial.

BACKGROUND: Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person. METHODS: We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED ('PREvención con DIeta MEDiterránea') study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality. RESULTS: During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend<0.05, all). Compared to non-consumers, subjects consuming nuts>3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts>3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66). CONCLUSIONS: Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk.Please see related commentary: http://www.biomedcentral.com/1741-7015/11/165. TRIAL REGISTRATION: Clinicaltrials.gov. International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks.

BACKGROUND: Blacks have disproportionately high rates of cardiovascular disease. Psychosocial stress may contribute to this disparity. Previous trials on stress reduction with the Transcendental Meditation (TM) program have reported improvements in cardiovascular disease risk factors, surrogate end points, and mortality in blacks and other populations. METHODS AND RESULTS: This was a randomized, controlled trial of 201 black men and women with coronary heart disease who were randomized to the TM program or health education. The primary end point was the composite of all-cause mortality, myocardial infarction, or stroke. Secondary end points included the composite of cardiovascular mortality, revascularizations, and cardiovascular hospitalizations; blood pressure; psychosocial stress factors; and lifestyle behaviors. During an average follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29-0.92; P=0.025). The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51-0.1.13; P=0.17). There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval -8.3 to -1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival. CONCLUSIONS: A selected mind-body intervention, the TM program, significantly reduced risk for mortality, myocardial infarction, and stroke in coronary heart disease patients. These changes were associated with lower blood pressure and psychosocial stress factors. Therefore, this practice may be clinically useful in the secondary prevention of cardiovascular disease. Clinical Trial Registration- URL: www.clinicaltrials.gov Unique identifier: NCT01299935.

[Study on the correlation between Chinese medicine syndrome types of the Uighur and Han people and levels of blood lipids and fibrinogen in premature coronary heart disease patients].

OBJECTIVE: To study the correlation between the Chinese medicine (CM) syndrome types of the Uighur and Han people and levels of blood lipids and fibrinogen in premature coronary heart disease (PCHD) patients. METHODS: Recruited were 196 Uighur and 189 Han patients with PCHD first confirmed by coronary angiography at the Heart Center of First Affiliated Hospital of Xinjiang Medical University and Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University. Another 60 healthy volunteers were recruited as the healthy control group. CM syndromes were typed by physicians or those having higher professional titles at the cardiac internal medicine. The contents of triglyceride (TG) and total cholesterol (TC) were detected using oxidase method. The high-density lipoprotein cholesterol (HDL-C) level was detected using chemical modification enzymic method. The low-density lipoprotein cholesterol (LDL-C) level was detected using selective dissolution. The fibrinogen (FIB) level was detected using Clauss congeal principle. RESULTS: The CM syndrome types of Uighurs were sequenced as filthy turbidity and phlegm obstruction syndrome (82 cases, 21.3%) > qi deficiency and blood stasis syndrome (61 cases, 15.84%) >cold accumulation in Xin meridian syndrome (39 cases, 10.13%) >Xin-Shen yin deficiency syndrome (14 cases, 3. 63%). The CM syndrome types of the Han nationality were sequenced as qi deficiency and blood stasis syndrome (69 cases, 17.92%) >filthy turbidity and phlegm obstruction syndrome (67 cases, 17.40%) > cold accumulation in Xin meridian syndrome (42 cases, 10.91%) > Xin-Shen yin deficiency syndrome (11 cases, 2.86%). There was no statistical difference in the syndrome type distribution between the two groups (P >0.05). Compared with the healthy control group, the levels of TG, LDL-C, and FIB increased, and the HDL-C level decreased in patients of filthy turbidity and phlegm obstruction syndrome and qi deficiency and blood stasis syndrome of the patient group. The HDL-C level decreased in the Uighur patients of Xin-Shen yin deficiency syndrome, showing statistical difference (P < 0.01, P < 0.05). Compared with the Han people of the same syndrome type, the TG level increased and the HDL-C level decreased in the Uighur patients of filthy turbidity and phlegm obstruction syndrome. The FIB level increased in the Uighur patients of qi deficiency and blood stasis syndrome with statistical difference (P<0.05). In the Uighur patients, filthy turbidity and phlegm obstruction syndrome was positively correlated with TG (r=0.469) and FIB (r=0.464), and negatively correlated with HDL-C (r=-0.382). Qi deficiency and blood stasis syndrome was positively correlated with FIB (r=0.72) with statistical difference (P<0.01, P<0.05). In the Han patients, filthy turbidity and phlegm obstruction syndrome was positively correlated with TG (r=0.445) and FIB (r=0.372), and negatively correlated with HDL-C (r=-0.37). Qi deficiency and blood stasis syndrome was positively correlated with TG (r=0.471) and FIB (r=0.459) with statistical difference (P<0.01, P<0.05). CONCLUSION: CM syndrome types were correlated with TG, HDL-C, and FIB in PCHD Han and Uighur patients.

Serum levels of marine-derived n-3 fatty acids in Icelanders, Japanese, Koreans, and Americans--a descriptive epidemiologic study.

In the 1990s Iceland and Japan were known as countries with high fish consumption whereas coronary heart disease (CHD) mortality in Iceland was high and that in Japan was low among developed countries. We described recent data fish consumption and CHD mortality from publicly available data. We also measured CHD risk factors and serum levels of marine-derived n-3 and other fatty acids from population-based samples of 1324 men in Iceland, Japan, South Korea, and the US. CHD mortality in men in Iceland was almost 3 times as high as that in Japan and South Korea. Generally, a profile of CHD risk factors in Icelanders compared to Japanese was more favorable. Serum marine-derived n-3 fatty acids in Iceland were significantly lower than in Japan and South Korea but significantly higher than in the US.

[A case control study of influential factors or the Han population with coronary heart disease of blood stasis syndrome in Fuzhou area].

OBJECTIVE: To study main factors and the influencing extent of the susceptibility of the Han population with coronary heart disease (CHD) of blood stasis syndrome (BSS) in Fuzhou area. METHODS: A case control study was employed in Fujian People's Hospital from August 2009 to January 2010. Patients with recent attack of CHD of BSS and of CHD of non-BSS, as well as patients without CHD of non-BSS were recruited as subjects. Correlated factors with CHD were collected using questionnaire and laboratory examinations. The correlation and the correlation strength between each factor and CHD of BSS were analyzed using one-way and multiple-factor unconditional Logistic regression methods. RESULTS: Of the 403 patients in line with inclusion criteria, there were 176 patients with CHD of BSS, 123 with CHD of non-BSS, and 104 without CHD of non-BSS. Results of one-way analysis were reported as follows. Senility, mental labors, hypertension, excessive consumption of oil and salt, depression, stress, past relevant medical history, abnormal prothrombin time (PT), and abnormal hematocrit (HCT) were high-risk factors for CHD of BSS. Regular physical exercise and adequate sleep were protective factors. Except for the effects by age and sex, mental labors, hypertension, excessive consumption of oil and salt, depression, stress, past relevant medical history were still risk factors for CHD of BSS, with the correlation strength (OR value, 95% CI) being 1.902 (95% CI 1.222-2.959), 2.221 (95% CI 1.181-4.176), 2.945 (95% CI 1.781 4.871), 1.794 (95% CI 1.114-2.890), 3.462 (95% CI 1.555-7.712), 1.517 (95% Cl 1.082-2.128), and 3.159 (95% CI 1.732-5.764). In the comparison between those with CHD of BBS and those with CHD of non-BBS, excessive consumption of salt and meat, and stress were the risk factors for BSS. After the effects by age and sex were adjusted, the OR value were still 1.586 (95% CI 1.051-2.393), 1.801 (95% CI 1.191-2.723), and 1.386 (95% CI 1.024-1.876). CONCLUSIONS: When compared with the population of non-BSS, the predisposing factors for the Han population with CHD of BSS in Fuzhou area covered mental labors, hypertension, excessive consumption of oil and salt, depression, stress, and past relevant medical history. Compared with other syndrome types in Chinese medicine, positive correlation existed between BSS and excessive consumption of salt and meat, as well as stress.

Explanatory models of coronary heart disease among South Asian immigrants.

OBJECTIVE: This study investigated South Asians' explanatory models (EM) of CHD and compared them to the biomedical model as part of an effort to inform the development of culturally targeted CHD prevention messages. METHODS: We conducted in-depth, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicago, Illinois. RESULTS: While EMs of CHD included risk factors from the biomedical model, they also included psychosocial and spiritual risk factors. Respondents emphasized that stress causes CHD and suggested that CHD was caused by sudden or inexplicable factors. Few respondents discussed cholesterol, blood pressure, or diabetes as part of CHD prevention. Women and those with lower education had low perceptions of being at-risk for CHD. CONCLUSION: South Asians' EMs of CHD encompassed the biomedical model; however, EMs also included psychosocial and spiritual factors. PRACTICE IMPLICATIONS: Clinicians and health educators should be aware that South Asian individual's EM of CHD may include psychosocial and spiritual factors which can affect CHD prevention behaviors.

[Relationship between polymorphism of platelet membrane glycoprotein IIIa and coronary heart disease with blood-stasis syndrome in Chinese Han population].

OBJECTIVE: To investigate the genotype distributions of PLA1/PLA2 polymorphism in Chinese Han population from Beijing and Hebei Province and to study the correlation between the platelet membrane glycoprotein IIIa polymorphism and coronary heart disease (CHD) or CHD with blood-stasis syndrome. METHODS: A total of 110 CHD patients with blood-stasis syndrome and 102 CHD patients with non-blood stasis syndrome were enrolled in the case-control study. Thirty-nine healthy volunteers were included as normal control. Syndrome differentiation in traditional Chinese medicine was performed in all of the patients. The genomic DNA was isolated from the whole blood and the locus typing of PLA was determined by TaqMan probe technology. RESULTS: The locus typing of PLA1/PLA2 gene polymorphism was exclusively PLA1/PLA1 (TT) in healthy people, CHD patients and CHD patients with blood-stasis syndrome, while GPIIIa PLA1/PLA2 (TC) and PLA2/PLA2 (CC) were not found in all the selected objects. Statistical analysis of locus typing for other PLA1/PLA1 polymorphisms was not made in the study. CONCLUSION: The PLA1/PLA2 polymorphism of membrane glycoprotein IIIa is not a risk factor for CHD patients or CHD patients with blood-stasis syndrome in Chinese Han population, and the related genes may be some other gene polymorphisms.

Engaging women from South Asian communities in cardiac rehabilitation.

This study sought to describe experiences and perceptions of cardiac rehabilitation among a sample of women from South Asian communities. Data were collected via eight semi-structured interviews with staff and a focus group discussion with nine clients from a community-based, culturally sensitive cardiac rehabilitation service. A number of individual, cultural and practical barriers to participation were identified. Facilitators centred on whether the format and content of the sessions could be considered "appropriate". For example, a women's dance group proved to be successful through the selection of a familiar local venue, supportive session leader, and activity that was felt to be both enjoyable and beneficial. This study has shown that it is possible to engage hard-to-reach groups in cardiac rehabilitation and physical activity. Further work is needed to explore whether this research is applicable in other ethnic groups and whether the lessons learned could be successfully incorporated into mainstream health services.

Riboflavin lowers homocysteine in individuals homozygous for the MTHFR 677C->T polymorphism.

BACKGROUND: Meta-analyses predict that a 25% lowering of plasma homocysteine would reduce the risk of coronary heart disease by 11% to 16% and stroke by 19% to 24%. Individuals homozygous for the methylenetetrahydrofolate reductase (MTHFR) 677C-->T polymorphism have reduced MTHFR enzyme activity resulting from the inappropriate loss of the riboflavin cofactor, but it is unknown whether their typically high homocysteine levels are responsive to improved riboflavin status. METHODS AND RESULTS: From a register of 680 healthy adults 18 to 65 years of age of known MTHFR 677C-->T genotype, we identified 35 with the homozygous (TT) genotype and age-matched individuals with heterozygous (CT, n=26) or wild-type (CC, n=28) genotypes to participate in an intervention in which participants were randomized by genotype group to receive 1.6 mg/d riboflavin or placebo for a 12-week period. Supplementation increased riboflavin status to the same extent in all genotype groups (8% to 12% response in erythrocyte glutathione reductase activation coefficient; P<0.01 in each case). However, homocysteine responded only in the TT group, with levels decreasing by as much as 22% overall (from 16.1+/-1.5 to 12.5+/-0.8 micromol/L; P=0.003; n=32) and markedly so (by 40%) in those with lower riboflavin status at baseline (from 22.0+/-2.9 and 13.2+/-1.0 micromol/L; P=0.010; n=16). No homocysteine response was observed in the CC or CT groups despite being preselected for suboptimal riboflavin status. CONCLUSIONS: Although previously overlooked, homocysteine is highly responsive to riboflavin, specifically in individuals with the MTHFR 677 TT genotype. Our findings might explain why this common polymorphism carries an increased risk of coronary heart disease in Europe but not in North America, where riboflavin fortification has existed for >50 years.

Eskimos have CHD despite high consumption of omega-3 fatty acids: the Alaska Siberia project.

OBJECTIVES: The thirty-year-old hypothesis that omega-3 fatty acid (FA) may "reduce the development of thrombosis and atherosclerosis in the Western World" still needs to be tested. Dyerberg-Bang based their supposition on casual observations that coronary atherosclerosis in Greenlandic Inuit was 'almost unknown' and that they consumed large amounts of omega-3 FAs. However, no association was demonstrated with data. STUDY DESIGN: Cross-sectional study. METHODS: 454 Alaskan Eskimos were screened for coronary heart disease (CHD), using a protocol that included ECG, medical history, Rose questionnaire, blood chemistries, including plasma FA concentrations, and a 24-hour recall and a food frequency questionnaire assessment of omega-3 FA consumption. RESULTS: CHD was found in 6% of the cohort under 55 years of age and in 26% of those > or = 55 years of age. Eskimos with CHD consume as much omega-3 FAs as those without CHD, and the plasma concentrations confirm that dietary assessment. CONCLUSIONS: Average daily consumption of omega-3 FAs among Eskimos was high, with about 3-4 g/d reported, compared with 1-2 g/d used in intervention studies and the average consumption of 0.2 g/d by the American population. There was no association between current omega-3 FA consumption/blood concentrations and the presence of CHD.

Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project.

OBJECTIVES: To test the hypothesis that the unusually low prevalences of insulin resistance (IR), metabolic syndrome (MS) and diabetes (DM) in Alaskan Eskimos, compared to American Indians, is related to the traditional Eskimo diet, high in C20-C22 omega-3 fatty acids (FAs). To determine if the relatively low blood pressures, low serum triglycerides and high HDL cholesterol levels in Eskimos result from high omega-3 FA consumption. STUDY DESIGN: Cross-sectional study. METHODS: We measured plasma FA concentrations in 447 Norton Sound Eskimos (35-74 years of age) and screened for DM, CHD and associated risk factors. A dietary assessment (24-hr recall) was obtained for comparison the day before the blood sampling. RESULTS: Plasma omega-3 FA concentrations were highly correlated with dietary omega-3 FAs and HDL levels and inversely correlated with plasma levels of insulin, 2-h insulin (OGTT), HOMI-IR, 2-h glucose (OGTT), triglyceride levels and diastolic blood pressure. CONCLUSIONS: High consumption of omega-3 FAs positively affects components of the MS, insulin sensitivity and glucose tolerance. This finding suggests that high consumption of C20-C22 omega-3 FAs protects against the development of the MS and glucose intolerance.

Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease.

BACKGROUND: Black subjects with a family history of premature coronary heart disease (CHD) have a marked excess risk, yet barriers prevent effective risk reduction. We tested a community-based multiple risk factor intervention (community-based care [CBC]) and compared it with "enhanced" primary care (EPC) to reduce CHD risk in high-risk black families. METHODS AND RESULTS: Black 30- to 59-year-old siblings of a proband with CHD aged <60 years were randomized for care of BP > or =140/90 mm Hg, LDL cholesterol > or =3.37 mmol/L, or current smoking to EPC (n=168) or CBC (n=196) and monitored for 1 year. EPC and CBC were designed to eliminate barriers to care. The CBC group received care by a nurse practitioner and a community health worker in a community setting. The CBC group was 2 times more likely to achieve goal levels of LDL cholesterol and blood pressure compared with the EPC group (95% CI, 1.11 to 4.20 and 1.39 to 3.88, respectively) with adjustment for baseline levels of age, sex, education, and baseline use of medications. The CBC group demonstrated a significant reduction in global CHD risk, whereas no reduction was seen in the EPC group (P<0.0001). CONCLUSIONS: Eliminating known barriers may not be sufficient to reduce CHD risk in primary care settings. An alternative community care model that addresses barriers may be a more effective way to ameliorate CHD risk in high-risk black families.

Cardiac health: relationships among hostility, spirituality, and health risk.

This study examined hostility, spirituality, and indices of health risk among 100 young, primarily males of Hispanic background. Over half of the subjects were prehypertensive or hypertensive; one third had at least 2 objective risk factors for cardiac disease; and younger participants had lower spirituality scores and higher cynical distrust scores. Body mass index, spirituality, and glucose accounted for 29% of variance in systolic blood pressure; body mass index and age accounted for 39% of variance in diastolic blood pressure. The tools to assess cardiac risk (blood pressure, history, capillary blood screening, body mass index) are all "low tech" and low cost but used together are powerful in identifying risk populations.

No association between plasma levels of plant sterols and atherosclerosis in mice and men.

OBJECTIVE: Sitosterolemia is characterized by elevated plasma levels of plant sterols, hypercholesterolemia and premature coronary heart disease (CHD). CHD develops in some subjects with sitosterolemia, despite having normal plasma cholesterol levels, suggesting that high circulating levels of plant sterols may be atherogenic. We tested whether elevated plasma levels of plant sterols (sitosterol and campesterol) were associated with atherosclerosis in genetically modified mice and in middle-aged men and women. METHODS AND RESULTS: Wild-type and hypercholesterolemic female mice with >20-fold higher plasma levels of plant sterols because of inactivation of the ATP-binding cassette (ABC) half transporters G5 and G8 (G5G8-/-mice) were fed chow or Western diets for 7 months. No significant differences in aortic lesion area were found when the sitosterolemic mice were compared with littermate controls. To determine whether plasma levels of plant sterols were associated with coronary atherosclerosis in humans, the relationship between plasma plant sterols and coronary calcium (detected by electron beam computer tomography) was examined in 2542 subjects aged 30 to 67 years. Plasma levels of cholesterol, but not sitosterol or campesterol, were significantly higher in subjects with coronary calcium. CONCLUSIONS: The results of this study do not support an association between elevated plasma levels of plant sterols and atherosclerosis.

Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men.

BACKGROUND: Reasons for the increase in mortality due to coronary heart disease (CHD) in UK Indian Asians are not well understood. In this study, we tested the hypotheses that elevated plasma homocysteine concentrations are a risk factor for CHD in Indian Asians, and explain part of their increased CHD risk, compared with Europeans. METHODS: We undertook two parallel case-control studies, one in Europeans and one in Indian Asians. We recruited 551 male cases (294 European, 257 Indian Asian) and 1025 healthy male controls (507 European, 518 Indian Asian). Fasting and post-methionine load homocysteine, vitamin B12 and folate concentrations, and conventional CHD risk factors were measured. FINDINGS: Fasting homocysteine concentrations were 8% higher (95% CI 3-14) in cases compared with controls, in both ethnic groups. The odds ratio of CHD for a 5 micromol/L increment in fasting plasma homocysteine was 1.3 (1.1-1.6) in Europeans and 1.2 (1.0-1.4) in Indian Asians. The association between fasting plasma homocysteine and CHD was independent of conventional CHD risk factors in both ethnic groups. Post-load homocysteine concentrations were not significantly different in cases compared with controls. Among the controls, fasting homocysteine concentrations were 6% (2-10) higher in Indian Asians than in Europeans. From the results we estimate that elevated homocysteine may contribute to twice as many CHD deaths in Indian Asians, compared with Europeans. The differences in homocysteine concentrations between the two ethnic groups were explained by lower vitamin B12 and folate levels in Asians. INTERPRETATION: Plasma homocysteine is a novel and independent risk factor for CHD in Indian Asians, and may contribute to their increased CHD risk. Raised homocysteine concentrations in Indian Asians may be related to their reduced vitamin B12 and folate levels, implying that the increased CHD risk in this group may be reduced by dietary vitamin supplementation.

Higher total homocysteine concentrations and lower folate concentrations in premenopausal black women than in premenopausal white women.

BACKGROUND: Premenopausal black women have a greater rate of coronary artery disease (CAD) than do premenopausal white women. Plasma total homocysteine concentrations, a risk factor for CAD, have not been reported in premenopausal black women. OBJECTIVE: The purpose of this study was to compare plasma total homocysteine, folate, and vitamin B-12 concentrations in premenopausal black and white women. DESIGN: Eighty-nine black and 90 white, healthy, premenopausal women living in Portland, OR, were recruited. Dietary histories were obtained by using the Diet Habit Survey, a 40-item eating-behavior questionnaire. Plasma concentrations of total homocysteine, folate, and vitamin B-12 were measured. RESULTS: Black women had higher plasma total homocysteine (8.32 compared with 7.60 micromol/L;P = 0. 013), lower plasma folate (6.62 compared with 9.88 nmol/L;P < 0. 0001), and higher vitamin B-12 (355 compared with 283 pmol/L;P < 0. 001) concentrations than white women. White women had a greater rate of daily multivitamin supplement use (42.4% compared with 24.7%;P = 0.019) and ate more ready-to-eat cereal than did black women. After adjustment for multivitamin use and intake of ready-to-eat cereal, plasma total homocysteine concentrations did not differ significantly, but plasma folate remained significantly lower in the black women. None of the black women but 12.3% of the white women (P = 0.013) were homozygous for the cytosine to thymidine mutation at nucleotide 677 in the methylenetetrahydrofolate reductase gene. CONCLUSIONS: Black women had higher plasma total homocysteine and lower plasma folate concentrations than white women, largely because of lifestyle factors, which may contribute to the greater rate of CAD in premenopausal black than in white women.

Vitamins, selenium, iron, and coronary heart disease risk in Indians, Malays, and Chinese in Singapore.

STUDY OBJECTIVE: To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is partly because of differences in antioxidants (vitamins A, C, and E, and selenium) and pro-oxidants (iron). DESIGN: Cross sectional study of the general population. SETTING: Singapore. PARTICIPANTS: Random sample of 941 persons aged 30 to 69 years. MAIN RESULTS: There were moderate correlations between vitamin A and vitamin E, and between these vitamins and selenium. Mean plasma vitamins A and E were similar by ethnic group. Vitamin A concentration for Indians were (men 0.66 and women 0.51 mg/l), Malays (men 0.67 and women 0.54 mg/l), and Chinese (men 0.68 and women 0.52 mg/l). Vitamin E concentrations for Indians were (men 12.9 and women 12.8 mg/l), Malays (men 13.6 and women 13.3 mg/l), and Chinese (men 12.6 and women 12.6 mg/l). In contrast, mean plasma vitamin C concentrations were lower in Indians (men 5.7 and women 6.9 mg/l) and Malays (men 5.1 and women 6.4 mg/l) than Chinese (men 6.3 and women 8.4 mg/l). Mean serum selenium was lower in Indians (men 117 and women 115 micrograms/l) than Malays (men 122 and women 122 micrograms/l) and Chinese (men 126 and women 119 micrograms/l). Mean serum ferritin was much lower in Indians (men 132 and women 50 micrograms/l) than Malays (men 175 and women 85 micrograms/l) and Chinese (men 236 and women 92 micrograms/l). MAIN CONCLUSIONS: Lower vitamin C and selenium in Indians, particularly in combination, could play a part in their increased risk of CHD. Vitamins A and E, and ferritin (iron) have no such role. Lower vitamin C in Indians and Malays is probably because of its destruction by more prolonged cooking. In Indians, lower selenium is probably because of a lower dietary intake and the much lower ferritin to a lower dietary intake of iron and its binding by phytates.