Homocysteine concentration and the risk of death in the adult Polish population.

BACKGROUND: Although there is a considerable epidemiologic evidence for a relation between homocysteine (Hcy) level and cardiovascular disease (CVD). The role of Hcy as a causal risk factor remains controversial.

AIM: To determine associations between Hcy level and all-cause and cardiovascular mortality in general population of Poland.

METHODS: Within the frame of the National Multicenter Health Survey (WOBASZ), a representative sample of whole Polish population aged 20-74 was screened in years 2003-2005 and prospectively followed up until 2009. Baseline determinations, among other classical risk factors, included Hcy level in 7165 responders, performed by an immunoenzymatic method using IMMULITE 1 analyser and DPC reagents. Survival rates were followed up until 2009 and average follow up time was 5.4 years.

RESULTS: During the 38,818.9 person-years of follow-up there were 270 deaths including 108 due to CVD, 37 due to coronary heart disease and 21 due to stroke. The relative risk of all-cause and CVD mortality was significantly higher in the highest (> 10.51 μmol/L) compared to the lowest (< 8.20 μmol/L) Hcy tercile in crude and multivariable proportional hazards models adjusted for sex, age, smoking status, hypertension, body mass index, total cholesterol, glucose and high sensitivity-C-reactive protein. Hazards ratios (95% confidence intervals) were as follows: all-cause mortality HR (95% CI): crude = 4.528 (2.947-6.154), multivariable-adjusted = 1.766 (1.197-2.605), CVD mortality crude = 4.322 (2.426-7.700), multivariable- -adjusted = 1.937 (1.051-3.569).

CONCLUSIONS: In Polish adult population Hcy concentration is independently associated with all-cause and CVD mortality.