TY - JOUR
T1 - Thermolabile methylenetetrahydrofolate reductase, homocysteine, and cardiovascular disease risk
T2 - The European concerted action project
AU - Meleady, Raymond
AU - Ueland, Per M.
AU - Bloin, Henk
AU - Whitehead, Alexander S.
AU - Refsum, Helga M.
AU - Daly, Leslie E.
AU - Vollset, Stein Emil
AU - Donohue, Cait
AU - Giesendorf, Belinda
AU - Graham, Ian M.
AU - Ulvik, Arve
AU - Zhang, Ying
AU - Morosen, Anne Lise Bjorke
AU - Robinson, Killian
AU - Brattström, Lars E.
AU - Palma-Reis, Roberto J.
AU - Boers, Godfried H.J.
AU - Sheahan, Richard G.
AU - Israelsson, Bo
AU - Uiterwaal, Cuno S.
AU - McMaster, Dorothy
AU - Verhoef, Petra
AU - Witteman, Jacqueline
AU - Rubba, Paolo
AU - Bellet, Hélène
AU - Wautrecht, Jan C.
AU - De Valk, Harold W.
AU - Sales Lúis, Armando C.
AU - Parrot-Roulaud, Fraņoise M.
AU - Tan, Kok Soon
AU - Garcon, Danielle
AU - Medrano, Maria José
AU - Candito, Mirande
AU - Evans, Alun E.
AU - Andria, Generoso
PY - 2003/1/1
Y1 - 2003/1/1
N2 - Background: Homozygotes for the thermolabile mutation (TT genotype) of the methylenetetrahydrofolate reductase (MTHFR; EC 1.5.1.20) enzyme have elevated plasma concentrations of the cardiovascular disease risk factor homocysteine, particularly if folate depleted. Objective: We examined the relations between thermolabile MTHFR, plasma homocysteine, plasma folate, and vascular disease risk. Design: This was a case-control comparison in 711 vascular disease cases and 747 controls from 9 European countries. Results: The TT genotype was associated with higher homocysteine and lower plasma folate than the CC and CT genotypes in both cases and controls and a nonsignificant increase in vascular disease risk (1.26; 95% CI: 0.88, 1.81; P = 0.20). The frequency of the TT genotype in cases was not significantly different from that in controls (12.8% compared with 10.8%). After adjustment for traditional risk factors, the TT genotype was associated with an odds ratio of 1.48 (1.0, 2.20) for risk of vascular disease. This risk was attenuated after further adjustment for homocysteine. In subgroups with homocysteine concentrations ≥9 μmol/L, risk tended to be higher in CC than in TT subjects. However, CC subjects were characterized by a higher prevalence of the conventional risk factors associated with both elevated plasma homocysteine and serum creatinine. After adjustment, the risk of vascular disease associated with each genotype was not significantly different. Conclusions: There was a strong graded association between homocysteine and vascular risk in all genotypes. MTHFR genotype is a key determinant of plasma total homocysteine concentrations. The initially nonsignificant risk estimate associated with the TT genotype was strengthened after adjustment for conventional cardiovascular disease risk factors but was attenuated after adjustment for plasma folate and total homocysteine. The modest risk increase conferred by the TT genotype is mediated mainly by increased total homocysteine and low plasma folate concentrations.
AB - Background: Homozygotes for the thermolabile mutation (TT genotype) of the methylenetetrahydrofolate reductase (MTHFR; EC 1.5.1.20) enzyme have elevated plasma concentrations of the cardiovascular disease risk factor homocysteine, particularly if folate depleted. Objective: We examined the relations between thermolabile MTHFR, plasma homocysteine, plasma folate, and vascular disease risk. Design: This was a case-control comparison in 711 vascular disease cases and 747 controls from 9 European countries. Results: The TT genotype was associated with higher homocysteine and lower plasma folate than the CC and CT genotypes in both cases and controls and a nonsignificant increase in vascular disease risk (1.26; 95% CI: 0.88, 1.81; P = 0.20). The frequency of the TT genotype in cases was not significantly different from that in controls (12.8% compared with 10.8%). After adjustment for traditional risk factors, the TT genotype was associated with an odds ratio of 1.48 (1.0, 2.20) for risk of vascular disease. This risk was attenuated after further adjustment for homocysteine. In subgroups with homocysteine concentrations ≥9 μmol/L, risk tended to be higher in CC than in TT subjects. However, CC subjects were characterized by a higher prevalence of the conventional risk factors associated with both elevated plasma homocysteine and serum creatinine. After adjustment, the risk of vascular disease associated with each genotype was not significantly different. Conclusions: There was a strong graded association between homocysteine and vascular risk in all genotypes. MTHFR genotype is a key determinant of plasma total homocysteine concentrations. The initially nonsignificant risk estimate associated with the TT genotype was strengthened after adjustment for conventional cardiovascular disease risk factors but was attenuated after adjustment for plasma folate and total homocysteine. The modest risk increase conferred by the TT genotype is mediated mainly by increased total homocysteine and low plasma folate concentrations.
KW - European Concerted Action Project
KW - Folate
KW - Homocysteine
KW - Ischemic heart disease
KW - Methylenetetrahydrofolate reductase
KW - MTHFR
KW - Vascular disease risk
UR - http://www.scopus.com/inward/record.url?scp=0037214152&partnerID=8YFLogxK
M3 - Article
C2 - 12499324
AN - SCOPUS:0037214152
SN - 0002-9165
VL - 77
SP - 63
EP - 70
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 1
ER -