Banu ÇAKIR, Sabahat TEZCAN, Dilek ASLAN, Gülşen HASÇELİK, Lale TOKGÖZOĞLU

A case control study assessing the relationship between coronary heart disease and serum vitamin B12, homocysteine and folic acid levels

Amaç: Koroner arter hastalığının yüksek serum homosistein; düşük vitamin B12 ve folik asit konsantrasyonu ile ilişkili olduğu hipotezini test etmek Gereç ve yöntemler: Toplum tabanlı bu vaka kontrol çalışmasında 304 koroner kalp hastası ("vaka") ve 301 EKG bulgusunda patoloji saptanmamış erişkin ("kontrol") kişi çalışma grubu olarak seçilmiştir. Bulgular: Vaka grubundaki kişilerin ortalama serum homosistein düzeyi (6.52±6.38, ortanca= 1.90), kontrol grubundakilerin serum ortalama homosistein değerinden (6.19±5.99, ortanca= 1.80) istatistiksel olarak anlamlı düzeyde farklı değildir (p= 0.556). Vaka grubundaki kişilerin ortalama serum folik asit düzeyi (6.76±3.10, ortanca= 6.10), kontrol grubundakilerin folik asit değerinden (6.32±2.54, ortanca= 6.20) yüksektir, ancak, bu ilişki istatistiksel olarak anlamlı değildir (p= 0.089). Diğer taraftan vaka grubundaki kişilerin ortalama seram vitamin B12 düzeyi (282.87±125.96, ortanca= 230.50), kontrol grubundakilerin vitamin B,2 değerinden (252.81±105.59, ortanca= 105.59) istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur (p=0.005). İleri analizlerde, yaş için kontrol edilerek, serum homosistein, vitamin B12 ve folik asit düzeyleri ile koroner kalp hastalığı arasındaki ilişki eş zamanlı değerlendirildiğinde, serum vitamin Bı2 düzeyinin koroner arter hastalığı açısından Önemli bir belirleyici olduğu saptanmıştır. Sonuç: Bu sonuçlar koroner arter hastalığı ile .yüksek serum homosistein düzeyleri arasındaki ilişkiyi desteklememektedir. Ancak, koroner arter hastalığı ile serum vitamin Bp düzeyleri arasında pozitif bir ilişki olasıdır. Çalışmada tüm olası karıştırıcı değişkenler kontrol edilemediği için bu ilişkinin ileri çalışmalarla tekrar incelenmesi uygun olacaktır.

Koroner arter hastalığı ve serum vitamin B12, homosistein ve folik asit düzeyleri arasındaki ilişkiyi inceleyen bir vaka-kontrol çalışması

Purpose: To test the hypothesis that the coronary heart disease is associ¬ated with high serum homocysteine and low vitamin B-12, and folic acid concentrations. Methods: In this population-based case control study, "304 cases" with is-chemic ECG findings and "301 controls" without ischemia in their ECGs were selected as the study population. Results: The mean value of serum homocysteine levels of the cases (6.52 umol/L ±6.38, median= 1.90) was not significantly higher than the values of the control group (6.19±5.99Limol/L, median= 1.80) (p= 0.556). The mean value the folic acid levels of the cases (6.76 ng/ml ±3.10, median= 6.10) were higher than the values measured for the control group (6.32 ng/ml ±2.54, median= 6.20). However, this difference was not statistically significant (p= 0.089). Serum vitamin B12 levels (mean =282.87 pg/ml ±125.96, inedian= 230.50), on the other hand, were found to be significantly higher in cases than those in the controls (mean =252.81 pg/ml ±105.59, median= 105.59) (p= 0.005). Multivariate analysis controlling for age and serum ho-mosistein, vitamin B12 and folic acid levels simultaneously suggested high vitamin B(2 as a significant predictor of coronary hearth disease. Conclusion: These results do not support the hypothesis that coronary heart disease is related to high serum homocysteine concentration. Yet, there is suggestive evidence of a positive association between coronary hearth disease and serum vitamin Bp levels. The results are not conclusive due to inability to adequately control for potential confounders.

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