Association between total homocyst(e)ine and the likelihood for a history of acute myocardial infarction by race and ethnicity: Results from the Third National Health and Nutrition Examination survey

Background Few studies examining the association between total homocyst(e)ine and coronary heart disease have included blacks or Hispanics. Methods Data from the third National Health and Nutrition Examination Survey (3173 patients), a nationally representative survey of US adults, were used to examine the relation between total homocyst(e)ine and an electrocardiogram or a physicianʹs diagnosis of acute myocardial infarction (259 patients) among whites, blacks, and Mexican Americans greater-or-equal, slanted40 years old. Results Vitamin B12 and serum folate concentrations were significantly lower among persons with a total homocyst(e)ine concentration greater-or-equal, slanted15 μmol/L than among those with a total homocyst(e)ine concentration less-than-or-equals, slant10 μmol/L. Persons with a total homocyst(e)ine concentration greater-or-equal, slanted15 μmol/L were also older and more likely to be hypertensive, have a higher cholesterol concentration, and smoke. Compared with persons with a total homocyst(e)ine concentration less-than-or-equals, slant10 μmol/L, persons with a concentration greater-or-equal, slanted15 μmol/L had an odds ratio (OR) for myocardial infarction of 1.8 (95% confidence interval [Cl], 1.2–2.9) after adjustment for cardiovascular disease risk factors. Similar associations were noted among whites (OR 1.8, 95% Cl, 1.1–3.1) and blacks (OR 1.9, 95% Cl, 0.8–4.2); a more modest association was noted among Mexican Americans (OR 1.2, 95% Cl, 0.3–5.0). The association between total homocyst(e)ine and myocardial infarction was also more pronounced in persons without hypertension or diabetes. Conclusions Almost a 2-fold increased likelihood of myocardial infarction among persons with a total homocyst(e)ine concentration greater-or-equal, slanted15 μmol/L was noted in this nationally representative survey. The magnitude of the association did not differ by race or ethnicity.