Dataset Information

Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis.

ABSTRACT:

Background

The association of homocysteine with coronary artery disease (CAD) has been explored previously with mixed findings. The present Systematic Review and Meta-Analysis (SRMA) has assessed the pooled estimate of association between homocysteine (Hcy) and CAD, and its variation over the period and geography.

Methods

Systematic literature search was done in PubMed, Scopus and Cochrane to identify the observational studies that have reported mean Hcy among cases (CAD) and control. The SRMA was registered in PROSPERO (ID-CRD42023387675).

Results

Pooled standardized mean difference (SMD) of Hcy levels between the cases and controls was 0.73 (95% CI 0.55-0.91) from 59 studies. Heterogeneity was high (I² 94%). The highest SMD was found among the Asian studies (0.85 [95% CI 0.60-1.10]), while the European studies reported the lowest SMD between the cases and controls (0.32 [95% CI 0.18-0.46]). Meta-regression revealed that the strength of association was increasing over the years (Beta = 0.0227, p = 0.048).

Conclusions

Higher homocysteine levels might have a significant association with coronary artery diseases, but the certainty of evidence was rated low, owing to the observational nature of the studies, high heterogeneity, and publication bias. Within the population groups, Asian and African populations showed a greater strength of association than their European and American counterparts, and it also increased over the years.

SUBMITTER: Unadkat SV

PROVIDER: S-EPMC10897093 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis.

Unadkat Sumit V SV Padhi Bijaya K BK Bhongir Aparna Varma AV Gandhi Aravind P AP Shamim Muhammad Aaqib MA Dahiya Neelam N Satapathy Prakasini P Rustagi Sarvesh S Khatib Mahalaqua Nazli MN Gaidhane Abhay A Zahiruddin Quazi Syed QS Sah Ranjit R Serhan Hashem Abu HA

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology 20240227 1

<h4>Background</h4>The association of homocysteine with coronary artery disease (CAD) has been explored previously with mixed findings. The present Systematic Review and Meta-Analysis (SRMA) has assessed the pooled estimate of association between homocysteine (Hcy) and CAD, and its variation over the period and geography.<h4>Methods</h4>Systematic literature search was done in PubMed, Scopus and Cochrane to identify the observational studies that have reported mean Hcy among cases (CAD) and cont ...[more]

PMID: 38409614

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Project description:Homocysteine (Hcy) elevation and vitamin D deficiency have emerged as potential markers of coronary artery disease (CAD). However, even tough hypovitaminosis D has been suggested to interfere with Hcy catabolism, no study has so far addressed the interaction of vitamin D and Hcy and their impact on CAD, that was the aim of present study. A cohort of consecutive patients undergoing coronary angiography in a single center were included and analyzed within the year 2019. Significant CAD was defined as at least 1 vessel stenosis > 50%, while severe CAD as left main and/or three-vessel disease. Hcy and vitamin D levels were assesssed at admission. We included 3150 patients undergoing coronary angiography at our centre, who were divided according to the quartiles values of vitamin D. Patients with lower levels of Vitamin D displayed a higher cardiovascular risk profile and a higher prevalence of CAD. We observed an inverse linear relationship between lower levels of vitamin D and higher Hcy (r = - 0.092, p < 0.001) and a higher prevalence of hyperhomocysteinemia in patients with lower quartiles values of vitamin D (p < 0.001). By forward conditional regression model, low vitamin D appeared as independent predictors of Homocysteine levels above the median (OR[95%CI] = 1.79[1.37-2.33], p < 0.001). In addition, patients with low vitamin D (below the median) and increased Hcy displayed a non-significantly higher rate of CAD (81% vs 77.7%, p = 0.13, adjusted OR[95%CI] = 1.16[0.88-1.54], p = 0.29) but a significant increase in the rate of severe left main/3-vessel CAD (37.4% vs 30.5%, p = 0.005, adjusted OR[95%CI] = 1.29[1.02-1.67], p = 0.04). Among patients with vitamin D levels above the median, Hcy levels did not impact on the prevalence and extent of CAD (77.7 vs 77.2%, p = 0.81, adjusted OR[95%CI] = 0.94[0.73-1.20], p = 0.60 for CAD and 31.8% vs 27.7%, p = 0.08, adjusted OR[95%CI] = 0.97[0.75-1.25], p = 0.81 for severe left main/3-vessel CAD). No significant interaction between Hcy and vitamin D with CAD or severe CAD was observed. The present study shows an independent inverse linear relationship between vitamin D and Hcy values. Moreover, the association of Hcy with the extent of CAD was significant only among patients with hypovitaminosis D, and not in the cohort of subjects with vitamin D levels above the median, suggesting that a normal vitamin D status can prevent the deleterious effects of hyperhomocysteinemia on coronary atherosclerosis, a hypothesis that certainly needs further confirmation in larger randomized trials.

Project description:BackgroundC1q tumor necrosis factor (TNF) related proteins 9 (CTRP9) is a novel adipocytokine that has been shown to have a cardioprotective effect in coronary artery disease (CAD). However, there are conflicting results on circulating levels of CTRP9 in patients with and without CAD. This meta-analysis was conducted to investigate the association between circulating CTRP9 levels and CAD.ObjectiveThe aim of this meta-analysis was to re-examine the relationship between circulating CTRP9 levels and CAD.MethodsWe searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang Data, and CBM for relevant studies up to October 2023, and 193 articles were identified. After reading the title, abstract and full text, a total of 25 articles were included in this meta-analysis. A prespecified protocol registered at INPLASY was followed (INPLASY202450066). Due to the high heterogeneity, we performed subgroup analyses and meta-regression based on patient characteristics, complications, clinical biochemical indicators, coronary artery lesion, and CAD classification. Publication bias was assessed using Egger's linear regression tests, Begg's rank correlation tests, and funnel plots.ResultsThe results showed that the patient with CAD had significantly lower circulating CTRP9 levels than the control group (Z = 3.26, P = 0.001). Subgroup analysis and meta-regression findings demonstrated that observed heterogeneity could be attributed to population distribution. Patient characteristics (year of publication, patients' age, and BMI), complications (diabetes and type 2 diabetes mellitus (T2DM)), clinical biochemical indicators, coronary artery lesion (stability of coronary atherosclerotic plaque, and the number of diseased coronary vessels), and classification of CAD were not identified as source of heterogeneity.ConclusionsThe meta-analysis confirmed that circulating CTRP9 levels in CAD patients are significantly lower than those in patients without CAD. The association may be modified by the population distribution.

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Dataset Information

Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis.

Background

Methods

Results

Conclusions

Publications

Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis.

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