Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 73 records · Page 4Linked to original sources

PubMed2003

Accelerated decline and prognostic impact of renal function after myocardial infarction and the benefits of ACE inhibition: the CATS randomized trial.

AIMS: Information regarding the cardiorenal axis in patients after a myocardial infarction (MI) is limited. We examined the change in renal function after a first MI, the protective effect of angiotensin converting enzyme (ACE) inhibition and the prognostic value of baseline renal function. METHODS AND RESULTS: The study population consisted of 298 patients with a first anterior wall MI who were randomized to the ACE inhibitor captopril or placebo after completion of streptokinase infusion. Renal function, by means of glomerular filtration rate (GFR), was calculated using the Cockroft-Gault equation (GFR(c)). In the placebo group, renal function (GFR(c)) declined by 5.5 min(-1)within 1 year, vs only 0.5 ml min(-1)in the ACE inhibitor group (P<0.05). This beneficial effect of captopril was most pronounced in patients with the most compromised renal function at baseline. The incidence of chronic heart failure (CHF) within 1 year increased significantly with decreasing GFR(c)(divided into tertiles: 24.0, 28.9, and 41.2%; P<0.01). The risk-ratio for GFR(c)<81 ml min(-1)vs >103 mL min(-1)was 1.86 (95% CI 1.11-3.13; P=0.019). CONCLUSIONS: Renal function markedly deteriorates after a first MI, but is significantly preserved by ACE inhibition. Furthermore, an impaired baseline renal function adds to the prognostic risk of developing CHF in patients after a first anterior MI.

Adult↗

PubMed2003

External validation is necessary in prediction research: a clinical example.

BACKGROUND AND OBJECTIVES: Prediction models tend to perform better on data on which the model was constructed than on new data. This difference in performance is an indication of the optimism in the apparent performance in the derivation set. For internal model validation, bootstrapping methods are recommended to provide bias-corrected estimates of model performance. Results are often accepted without sufficient regard to the importance of external validation. This report illustrates the limitations of internal validation to determine generalizability of a diagnostic prediction model to future settings. METHODS: A prediction model for the presence of serious bacterial infections in children with fever without source was derived and validated internally using bootstrap resampling techniques. Subsequently, the model was validated externally. RESULTS: In the derivation set (n=376), nine predictors were identified. The apparent area under the receiver operating characteristic curve (95% confidence interval) of the model was 0.83 (0.78-0.87) and 0.76 (0.67-0.85) after bootstrap correction. In the validation set (n=179) the performance was 0.57 (0.47-0.67). CONCLUSION: For relatively small data sets, internal validation of prediction models by bootstrap techniques may not be sufficient and indicative for the model's performance in future patients. External validation is essential before implementing prediction models in clinical practice.

Bacterial Infections↗

PubMed2003

Role of history and physical examination in preoperative evaluation.

BACKGROUND AND OBJECTIVE: Since reports have shown that outpatient preoperative evaluation increases the quality of care and cost-effectiveness, an increasing number of patients are being evaluated purely on an outpatient basis. To improve cost-effectiveness, it would be appealing if those patients who are healthy and ready for surgery without additional testing could be easily distinguished from those who require more extensive evaluation. This paper examines whether published studies provide sufficient data to determine how detailed preoperative history taking and physical examination need to be in order to assess the health of surgical patients and to meet the objective of easy and early distinction. METHODS: A MEDLINE search was conducted from 1991 to 2000 with respect to preoperative patient history and physical examination. Altogether, 213 articles were found, of which 29 were selected. Additionally, 38 cross-references, 7 articles on additional testing and 4 recently published papers were used. RESULTS: It is questionable to what extent an extensive history is relevant for anaesthesia and long-term prognosis. With respect to physical examination, it seems unreasonable to diagnose valvular heart disease based on cardiac auscultation only, and it is unclear which method should be used to predict the difficulty of endotracheal intubation. The benefits of routine testing for all surgical patients before operation are extremely limited and are not advocated. CONCLUSIONS: The amount of detail of preoperative patient history and the value of physical examination to obtain a reasonable estimate of perioperative risk remains unclear. Although not evidence based, a thorough history taking and physical examination of all patients before surgery seems important until more evidence-based guidelines become available. Diagnostic and prognostic prediction studies may provide this necessary evidence.

Diagnostic Tests, Routine↗

PubMed2003

Phytoestrogens and breast cancer risk. Review of the epidemiological evidence.

Phytoestrogens are natural plant substances. The three main classes are isoflavones, coumestans, and lignans. Phytoestrogens have anticarcinogenic potential, but they have also significant estrogenic properties. For an evaluation of the effect of phytoestrogens on breast cancer risk we reviewed the analytical epidemiological data. A total of 18 studies were included. Up to now, there are 13 studies that have assessed the direct relation between the individual dietary intake of soy products and the risk of breast cancer. Overall, results do not show protective effects, with the exception maybe for women who consume phytoestrogens at adolescence or at very high doses. Only four of these 13 studies are prospective, and none of them found statistically significant breast cancer reductions. Four studies assessed urinary isoflavones excretion in relation to breast cancer. Three of these are case control studies, where excretion was measured after breast cancer occurrence and thus seriously limiting causal interpretation of the results. The only prospective study with urinary measurements before breast cancer occurrence was done in a Dutch postmenopausal population and showed a non-significant breast cancer risk reduction for high excretion. Three studies measured enterolactone (lignan): two case control studies reported a preventive effect on breast cancer risk, but the only prospective study did not . In conclusion, few prospective studies (n = 5) were done to assess the effects of phytoestrogens on breast cancer risk. None of them found protective effects. However, these prospective studies did not focus on 'age at consumption', which seems to be important based on results from dietary case control studies done so far.

4-Butyrolactone↗

PubMed2003

The Atherosclerosis Risk in Young Adults (ARYA) study: rationale and design.

INTRODUCTION: Despite recent advances in treatment, cardiovascular disease (CVD) is still health problem number one in western societies. Aiming at specific prevention strategies for high-risk individuals and shifting the available prevention programs towards younger age groups might increase the success of primary prevention. However, before addressing age-specific prevention programs, more insight in the determinants of early vascular damage and increased cardiovascular risk is warranted as well as insight in determinants increased cardiovascular risk, including vascular damage, at an early age. The Atherosclerosis Risk in Young Adults (ARYA) study was specifically designed to address this issue. OBJECTIVES: The ARYA study started off with studies evaluating (1) whether it is possible to predict cardiovascular risk at young adulthood by routinely measured adolescent data, and (2) evaluating the role of birth characteristics and adolescent characteristics to the development of vascular damage at young adulthood. METHODS: The ARYA study comprises of two cohorts of young adults. The Utrecht cohort includes 750 young adults, aged 27-30 years. The Hague-cohort includes 261 young adults born between 1963 and 1968. Data on birth characteristics, growth in early infancy as well as adolescent anthropometry, blood pressure, lipids, body mass index were obtained from the original medical records of the Municipal Health Service. In 1999/2001, the extent of subclinical vascular damage was measured using carotid wall thickness and aortic stiffness. Also, data on adult cardiovascular risk profile, bone density and central blood pressure were assessed, fasting blood was drawn and timed overnight urine samples were collected. CONCLUSION: The ARYA study is aimed to provide data on early determinants of cardiovascular risk, including vascular damage, at an early age. This knowledge enhances the understanding of atherosclerosis development and CVD risk and is needed to improve the available primary prevention programs.

Adolescent↗

PubMed2003

Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: the Atherosclerosis Risk in Young Adults study.

UNLABELLED: Obesity has become a major health problem in Western societies by increasing the risk of atherosclerosis and cardiovascular disease. Although data on tracking of body mass index (BMI) are available, little is known about the impact of weight change over time on the development of vascular damage. OBJECTIVE: To evaluate the relationship between adolescent BMI as well as change in BMI from adolescence into young adulthood and cardiovascular risk, as estimated by common carotid intima-media thickness (CIMT). DESIGN: Cohort study. SUBJECTS: A total of 750 healthy young adults, aged 27-30 y, who attended secondary school in Utrecht, the Netherlands. MEASUREMENTS: Data on adolescent weight, height, blood pressure and puberty stage were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and fasting blood sample was drawn and common CIMT was measured. RESULTS: One standard deviation (s.d.) increase in adolescent BMI was associated with 2.3 microm [95% confidence interval (CI): 1.3; 3.3] increase in mean common CIMT in young adults after adjustment for gender, adolescent age, adolescent blood pressure, puberty stage and lumen diameter. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1). Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common CIMT compared to those who showed relative weight loss over time (mean difference 14.7 mum; P<0.001). These latter showed similar CIMT values as individuals with constant low BMI. CONCLUSION: Adolescent BMI predicts cardiovascular risk, as estimated by common CIMT in young adulthood. Individuals who experience the largest increase in BMI and those who remain overweight over time have the thickest common CIMT.

Adolescent↗

PubMed2003

Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials.

The objective of the study was to assess the blood pressure response to changes in sodium and potassium intake and examine effect modification by age, gender, blood pressure, body weight and habitual sodium and potassium intake. Randomised trials of sodium reduction or potassium supplementation and blood pressure were identified through reference lists of systematic reviews and an additional MEDLINE search (January 1995-March 2001). A total of 40 sodium trials and 27 potassium trials in adults with a minimum duration of 2 weeks were selected for analysis. Data on changes in electrolyte intake and blood pressure during intervention were collected, as well as data on mean age, gender, body weight, initial electrolyte intake and initial blood pressure of the trial populations. Blood pressure effects of changes in electrolyte intake were assessed by weighted metaregression analysis, overall and in strata of trial population characteristics. Analyses were repeated with adjustment for potential confounders. Sodium reduction (median: -77 mmol/24 h) was associated with a change of -2.54 mmHg (95% CI: -3.16, -1.92) in systolic blood pressure and -1.96 mmHg (-2.41, -1.51) in diastolic blood pressure. Corresponding values for increased potassium intake (median: 44 mmol/24 h) were -2.42 mmHg (-3.75, -1.08) and -1.57 mmHg (-2.65, -0.50). Blood pressure response was larger in hypertensives than normotensives, both for sodium (systolic: -5.24 vs -1.26 mmHg, P < 0.001; diastolic: -3.69 vs -1.14 mmHg, P < 0.001) and potassium (systolic: -3.51 vs -0.97 mmHg, P=0.089; diastolic: -2.51 vs -0.34 mmHg, P=0.074). In conclusion, reduced intake of sodium and increased intake of potassium could make an important contribution to the prevention of hypertension, especially in populations with elevated blood pressure.

Blood Pressure↗

PubMed2003

Treatment with hormone replacement therapy lowers remnant lipoprotein particles in healthy postmenopausal women: results from a randomized trial.

BACKGROUND: Recent evidence indicates that remnant lipoprotein particles (RLPs) may play a role in atherosclerosis. Remnant lipoprotein particles have been suggested to be the most atherogenic particles among the triglyceride-rich lipoproteins. In particular, these triglyceride-rich particles were identified as an independent risk factor for cardiovascular diseases (CVD) in women. Postmenopausal hormone replacement therapy (HRT) beneficially affects lipid profile, although total triglyceride levels often increase. Evidence on the effects of HRT on RLPs is limited. We determined whether 3 months' treatment of postmenopausal women with Tibolone or conjugated oestrogens combined with medroxyprogesterone acetate (CEE + MPA) affects RLP-cholesterol (RLP-C). MATERIALS AND METHODS: One hundred and five healthy postmenopausal women were randomized to either 2.5 mg of Tibolone, 0.625 mg of CEE + 2.5 mg of MPA or placebo. At baseline and after 3 months the lipid profile was determined. For assessment of RLP-C we used an immunoseparation-based method. RESULTS: Treatment with CEE + MPA significantly reduced RLP-C (-0.03 mmol L-1, P-value = 0.01) and appeared to increase triglycerides (0.15 mmol L-1, P-value = 0.20) compared with placebo. Tibolone did not significantly change RLP-C (-0.01 mmol L-1, P-value = 0.35) and significantly decreased triglycerides (-0.35 mmol L-1, P-value = 0.004). CONCLUSIONS: Treatment of postmenopausal women with conjugated oestrogens and medroxyprogesterone acetate reduced RLP-C, without a reduction in total triglycerides, whereas Tibolone did affect triglyceride levels, but not RLP-C. These observations may be relevant for explaining the effect of HRT on cardiovascular risk in healthy postmenopausal women.

Aged↗

PubMed2003

Aortic stiffness and carotid intima-media thickness: two independent markers of subclinical vascular damage in young adults?

BACKGROUND: Previous reports have shown that carotid intima-media thickness (CIMT) and arterial stiffness are strong predictors of subsequent cardiovascular disease (CVD) morbidity and mortality, and are well related to an unfavourable cardiovascular risk profile in middle-aged and older subjects. These similarities suggest that arterial stiffness may play a role in the development of atherosclerosis or vice versa. However, studies show conflicting results and are limited to elderly subjects. To study this issue further, we evaluated the relation of arterial stiffness to subclinical atherosclerosis in 524 healthy young adults, aged 27-30 years. METHODS AND RESULTS: Aortic stiffness was assessed using pulse wave velocity (PWV) and CIMT was used as measure of subclinical atherosclerosis. The positive crude correlation between for mean arterial pressure adjusted PWV and CIMT (Pearson's correlation coefficient: 0.11; P=0.016) attenuated after adjustment for common determinants of both measurements like gender and age (partial correlation coefficient: 0.03; P=0.512). Furthermore, multivariate linear regression models showed that male gender, age and blood pressure were independent determinants of both CIMT and PWV while body mass index and LDL-cholesterol were independent determinants of CIMT only. CONCLUSIONS: These observations suggest that in healthy young adults arterial stiffness and CIMT reflect two separate entities of vascular damage.

Adult↗

PubMed2003

High prevalence of secondary hypertension and insulin resistance in patients with refractory hypertension.

OBJECTIVE: To determine causes of treatment resistance in patients with refractory hypertension, and to estimate the prevalence of true resistant hypertension. METHODS: We studied 50 consecutive patients referred with refractory hypertension after exclusion of hypokalemia and stenosis of the renal artery. Ambulatory blood pressure monitoring was performed in all patients to detect white-coat effect. The patients were hospitalized, antihypertensive drugs were withdrawn and a screening for secondary hypertension was performed. In addition, these patients, and a control group of essential hypertensives controlled with three antihypertensive drugs, underwent a OGTT with 75 g of glucose. RESULTS: Primary normokalemic hyperaldosteronism was diagnosed in seven patients. Two patients had a pheochromocytoma and six had white-coat effect. The 35 remaining patients with true resistant hypertension shown significant differences in serum insulin and HOMA IR when compared with the control group. CONCLUSIONS: These findings show that among normokalemic treatment-resistant hypertension, the presence of hyperaldosteronism and pheochromocytoma is quite high. Moreover, treatment resistance in hypertensive patients appears to be associated with insulin resistance.

Adrenal Gland Neoplasms↗

PubMed2003

Parental perception of educational, behavioural and general health problems in school-age survivors of bacterial meningitis.

AIM: To determine the occurrence of educational, behavioural and general health problems in Dutch school-age survivors of bacterial meningitis. METHODS: A cohort of 680 school-age survivors of meningitis caused by the most common Gram-positive and Gram-negative bacteria was established approximately 6y after the children's illness. Children with Haemophilus influenzae type b (Hib) meningitis were excluded because this form of the disease has virtually disappeared. Parents completed questionnaires on educational, behavioural and general health problems. The reference group comprised 304 school-age siblings and peers. RESULTS: Postmeningitic children were more likely than controls to under achieve at school: 20% vs 5% (odds ratio 5.6; 95% confidence interval 3.0-10.7). The postmeningitic children repeated a year twice as often as the children in the reference group (16% vs 8%, odds ratio: 2.5, 95% confidence interval 1.5-4.2) and were referred to a special-needs school four times more frequently (8% vs 2%, odds ratio: 5.5; 95% confidence interval 2.0-15.4). Parents also reported more behavioural problems at home. More than half of the postmeningitic children experienced general health problems. The causative pathogen or age at infection had no influence on the relative frequency of educational and behavioural problems, and reduced auditory functioning played only a small part in these problems. CONCLUSION: Parents perceive educational, behavioural and general health problems in more than 30% of postmeningitic children. Until it is clear which children are at highest risk of developing these problems, it will be necessary to follow postmeningitic children into their school-age years.

Child↗

PubMed2003

Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study.

OBJECTIVE: To estimate the incidence, survival, and lifetime risk of stroke in the elderly population. METHODS: The authors conducted a study in 7,721 participants from the population based Rotterdam Study who were free from stroke at baseline (1990-1993) and were followed up for stroke until 1 January 1999. Age and sex specific incidence, case fatality rates, and lifetime risks of stroke were calculated. RESULTS: Mean follow up was 6.0 years and 432 strokes occurred. The incidence rate of stroke per 1,000 person years increased with age and ranged from 1.7 (95% CI 0.4 to 6.6) in men aged 55 to 59 years to 69.8 (95% CI 22.5 to 216.6) in men aged 95 years or over. Corresponding figures for women were 1.2 (95% CI 0.3 to 4.7) and 33.1 (95% CI 17.8 to 61.6). Men and women had similar absolute lifetime risks of stroke (21% for those aged 55 years). The survival after stroke did not differ according to sex. CONCLUSIONS: Stroke incidence increases with age, also in the very old. Although the incidence rate is higher in men than in women over the entire age range, the lifetime risks were similar for both sexes.

Aged↗

PubMed2002

[Possibilities and limitations of genetic research; an advisory report from the Advisory Council on Health Research].

The Raad voor Gezondheidsonderzoek [Advisory Council on Health Research] has issued a report entitled 'New applications of genetic information in health care: which knowledge is needed?' The report is limited to areas where research is likely to have consequences within the relatively short time-span of a few years. These include genetics in diagnostics and screening, pharmacogenetics, and certain inherited diseases in adult age. Complex diseases such as multifactorial ones are not addressed. The report provides a useful overview of the prospects and problems in genetic research and how it will be applied in the years to come. Societal consequences of genetic research are also discussed. To enhance the understanding of complex diseases, epidemiological studies with long-term follow-up that combine genetic data with other data are essential. At the same time, potential privacy risks should be acknowledged and scientists should take extreme care in collecting, handling and analysing such data. The Netherlands Federation of Societies for Medical Research has produced guidelines which researchers should follow when carrying out their research.

Ethics, Medical↗

PubMed2002

[Cardiovascular risk factors. I. Review of possible causes of heart and vascular diseases].

Despite the decline in the past 30 years in age-adjusted mortality, cardiovascular disease is still the most important cause of morbidity and mortality in the Western world and increasingly so in the non-Western world. The decreased mortality rate is attributed to increased knowledge of the risk factors, a concomitant healthier life style and improved treatment for the risk factors. It has been clearly demonstrated that increased serum levels of cholesterol, increased blood pressure, the presence of diabetes, physical inactivity and smoking increase the risk of cardiovascular disease. The role of estrogens, homocysteine, thrombotic and inflammatory factors is currently the subject of considerable research. It seems likely that a certain genetic constitution enhances the susceptibility to the effects of other risk factors. New candidate genes are being suggested daily. Until now, no clearly decisive results have been achieved in determining the relations between the investigated genetic polymorphisms and the occurrence of cardiovascular disease. The consumption of foodstuffs that are rich in anti-oxidants seems to reduce the risk of cardiovascular disease, but randomised research into the effects of anti-oxidants as food supplements suggests that this does not affect the development of cardiovascular disease.

Antioxidants↗

PubMed2002

[Cardiovascular risk factors. II. Signs of vascular damage: practical implications].

In recent years, an increasing amount of information has become available on new indicators of cardiovascular damage, their determinants and the value of these indicators in the prediction of the development of cardiovascular disease. These indicators include carotid intima-media thickness, ECG characteristics, endothelial function and the measurement of coronary calcium. These indicators are currently used predominantly in cardiovascular disease research. At present, only limited information is available as to whether these indicators are useful in clinical practice for estimating the absolute risk of cardiovascular disease in an individual. The relative value of these newer indicators compared to the routinely collected risk factor information such as medical history, lifestyle, anthropometric variables, blood pressure and lipids is also not yet well established. The recent Dutch guidelines for the initiation of treatment with blood pressure lowering and lipid lowering drugs as a function of the absolute risk of cardiovascular disease within 10 years for the individual patient point toward the urgent necessity for research in the area of new risk indicators of vascular damage.

Cardiovascular Diseases↗

PubMed2002

Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly: the Rotterdam study.

BACKGROUND: Few studies have quantified the relation between carotid plaques and stroke in asymptomatic patients, and limited data exist on the importance of location of plaques or the association with subtypes of cerebral infarction. We investigated the relationship between carotid plaques, measured at different locations, and risk of stroke and subtypes of cerebral infarction in a population-based study. Methods and Results- The study was based on the Rotterdam Study and included 4217 neurologically asymptomatic subjects aged 55 years or older. Presence of carotid plaques at 6 locations in the carotid arteries was assessed at baseline. Severity was categorized according to the number of affected sites. After a mean follow-up of 5.2 years, 160 strokes had occurred. Data were analyzed using Cox proportional hazards regression. Plaques increased the risk of stroke and cerebral infarction approximately 1.5-fold, irrespective of plaque location. Severe carotid plaques increased the risk of nonlacunar infarction in anterior (RR 3.2 [95% CI, 1.1 to 9.7]) but not in posterior circulation (RR 0.6 [95% CI, 0.1 to 4.9]). A >10-fold increased risk of lacunar infarction was found in subjects with severe plaques (RR 10.8 [95% CI, 1.7 to 69.7]). No clear difference in risk estimates was seen between ipsilateral and contralateral infarction. CONCLUSIONS: Carotid plaques increase the risk of stroke and cerebral infarction, irrespective of their location. Plaques increase the risk of infarctions in the anterior but not in the posterior circulation. It is likely that carotid plaques in neurologically asymptomatic subjects are both markers of generalized atherosclerosis and sources of thromboemboli.

Aged↗

PubMed2002

Identifying patients for blood conservation strategies.

BACKGROUND: Generally, only the type of operation is used to estimate the need for perioperative homologous blood transfusion. This study quantified the extent to which the estimation could be improved if, in addition, simple patient characteristics were taken into account. METHODS: Retrospective data on 24 509 consecutive adult surgical patients were used to derive and validate three models to predict perioperative homologous transfusion. The first model was a univariable model with type of operation as the only predictor. The second and third models were a full and a simplified multivariable logistic regression model. The performance of the multivariable models was tested in two validation sets: in similar patients who had operations in the same general hospital (internal validation) and in patients who had operations in a university hospital (external validation). The areas under the receiver-operator characteristic (ROC) curve were compared with that found in the derivation set. RESULTS: There were no important differences in characteristics between the derivation and validation sets. The ROC area of the model including surgery only was 0.92 (99 per cent confidence interval (c.i.) 0.91 to 0.94) and that of the full and simplified multivariable models 0.95 (99 per cent c.i. 0.94 to 0.96) and 0.94 (99 per cent c.i. 0.93 to 0.95) respectively. The latter two were significantly different from the first one. In the external validation set the ROC area of the simplified model was 0.84 (95 per cent c.i. 0.83 to 0.86). Patients who had a preoperative haemoglobin level lower than 13 g/dl and underwent major invasive surgery had the highest risk (43 per cent) of transfusion. CONCLUSION: A simple algorithm using type of operation and haemoglobin concentration was effective in identifying patients likely to need perioperative homologous blood transfusion.

Adult↗

PubMed2002

Homocysteine and the stage of atherosclerotic disease: a study in patients suffering from clinically silent and clinically manifest atherosclerotic disease.

BACKGROUND: Elevated serum levels of homocysteine are considered a risk factor for cardiovascular disease. It has been suggested that homocysteine is a late stage predictor of adverse cardiovascular events, which might explain reported controversies in literature. The objective of the present study was to study the relationship between homocysteine levels and the stage of atherosclerotic disease. METHODS: In a cross-sectional study we compared the prevalence of hyperhomocysteinemia in high risk patients without silent or clinically overt atherosclerosis (group I, n = 196) with two patient groups: patients with clinically manifest atherosclerosis in the past or asymptomatic atherosclerosis (group II, n = 364) and patients who currently suffer from a clinically relevant manifestation of ischemic cardiovascular disease (group III, n = 967). In addition, we related homocysteine levels with a cumulative index of atherosclerotic disease (SMART-score). RESULTS: Homocysteine levels (micromol L(-1)) for the different groups were 13.5 +/- 8.9 (group I), 13.7 +/- 8.2 (group II) and 14.7 +/- 7.7 (group III). After adjustment for age, body mass index, creatinine levels and current use of vitamins, no significant differences in the prevalence of hyperhomocysteinemia were observed, compared with the reference category. Linear regression analysis revealed a significant relationship between Smart score and homocysteine levels that remained after adjustment for potential confounders (Beta = 0.36 (0.14-0.59), P = 0.001). CONCLUSION: If homocysteine levels are associated with the presence and indicators of atherosclerotic plaque burden, then this relationship is apparently not affected by the stage of atherosclerotic disease.

Adult↗