Influence of high homocysteine and low folate plasmatic levels in medium-term prognosis after acute coronary syndromes

Background To test prospectively whether moderate hyperhomocysteinemia and low folate levels could have an influence in the prognosis of 155 patients who presented with an acute coronary syndrome. Methods and results After a mean follow-up of 13.4 ± 7.4 months, patients with low folate levels had higher percentages of cardiovascular death and major cardiovascular events (33% vs. 5%, p < 0.001; 44% vs. 22%, p < 0.05) and patients with high homocysteine levels had a higher percentage of major cardiovascular events (31% vs. 14.5%, p < 0.03). Kaplan–Meier survival estimates analysis showed that patients with low folate levels had a significantly higher probability of cardiovascular death and lower free-of-events survival (log rank statistic: 21.17, p < 0.001 and 6.59, p = 0.01). Patients with high homocysteine levels had a lower free-of-events survival (log rank statistic: 4.95, p = 0.02). Different survival multivariate analysis model showed that the presence of low folate levels was an independent predictor of cardiovascular death (hazard ratio 8.85, 95% confidence interval 2.6–29.3, p < 0.000) and high homocysteine levels was identified as independent predictor of major cardiovascular events (hazard ratio 2.34, 95% confidence interval 1.07–5.12, p < 0.03). Conclusions Low folate levels and moderate hyperhomocysteinemia were identified as independent predictors of cardiovascular events in the follow-up.