Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study

Objectives. Elevated homocysteine increases the risk of vascular disease, in particular amongst younger subjects (<60 years). Very few studies have been performed amongst older subjects. We evaluated the relation of plasma total homocysteine (tHcy) to atherosclerosis and symptomatic cardiovascular disease amongst older men and women. Design. A cross-sectional study. Setting. General population. Subjects. A random sample of 630 men and women, participating in the Rotterdam Study, a prospective population-based cohort study amongst 7983 Subjects aged 55 years and over residing in the Ommoord district of Rotterdam, the Netherlands. Main outcome measures. Carotid atherosclerosis (carotid plaques and common carotid intima-media thickness) assessed by ultrasonography; lower extremity (peripheral) artery atherosclerosis measured by the ratio of the ankle to arm systolic blood pressure; prevalent cardiovascular disease assessed as a history of myocardial infarction or stroke. Results. Subjects, 55-74 years of age, with elevated tHcy levels (≤18.6 μmol L^-1) had a thicker common carotid intima-media (difference 0.037 mm: 95% CI 0.001, 0.073), a lower ankle-arm index (1-0.054: -0.104, -0.004), and an increased risk of cardiovascular disease (odds ratio 3.0: 1.5, 6.1), after adjusting for sex and age. There was no appreciable association of tHcy levels to atherosclerosis and cardiovascular disease in subjects aged 75 years and older. Conclusions. In subjects aged 55-74 years elevated tHcy is associated with an increased risk of atherosclerosis and cardiovascular disease. The lack of association in those aged ≤75 years most probably reflect selective mortality.