Elevated homocysteine level and prognosis in patients with acute coronary syndrome: a meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies
PubMed 30821522 · doi:10.1080/1354750X.2019.1589577
What was done
Meta-analysis of prospective observational studies identified through PubMed and Embase searches up to August 2018. The authors evaluated the prognostic association between baseline homocysteine levels (comparing highest versus lowest categories) and outcomes—major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality—in patients with acute coronary syndrome (ACS). Pooled risk ratios (RR) and 95% confidence intervals (CI) adjusted for confounding factors were calculated.
What was found
Across 10 included studies comprising 4,120 ACS patients, the highest versus lowest homocysteine level was associated with: - Significantly increased risk of MACE: RR 2.01 (95% CI 1.53–2.64) - Significantly increased risk of all-cause mortality: RR 2.05 (95% CI 1.50–2.79) - No statistically significant association with cardiovascular mortality: RR 1.08 (95% CI 0.83–1.39)
Why it matters
This meta-analysis consolidates conflicting observational literature to show that elevated homocysteine correlates with adverse overall clinical prognosis and total mortality in ACS patients, though its specific role in cardiovascular mortality remains unconfirmed.
Limits
All included data derive from observational studies, precluding causal inference. Thresholds defining highest versus lowest homocysteine levels, length of follow-up, and specific confounding adjustments were not standardized across primary studies. The abstract does not report heterogeneity statistics, individual study quality assessments, or potential publication bias.
Cited by
- supports Elevated homocysteine levels are associated with poor outcomes in cardiovascular disease.