1015-73 Relationship Between Homocyst(e)ine, Vitamin B12 and Cardiac Disease in the Elderly

Elevated plasma homocyst(e)ine (HCS) is an independent risk factor for coronary artery disease (CAD) among middle aged adults. Moveover, HCS also increases with age. This study assessed plasma HCS among 384 elderly (ages 73±7 y) patients undergoing coronary angiography. The degree of CAD was scored using proximal and diffuse (Freisenger) indices. Plasma HCS, serum Vitamin B12 and folate and left ventricular ejection fraction (LVEF) were measured and risk factors for CAD were recorded. There was no apparent correlation between plasma HCS and extent of CAD after adjusting for age. Nine percent of patients (pts) had Vitamin B12 deficiency (B12 def), ie. Vitamin B12. <300pg/ml as well as HCS >16nmol/ml. LVEF for the 32 B12 def pts=40.5% was significantly less than for 326 non B12 def pts with LVEF=50.6% (p<0.001). Significance remained after adjusting for proximal and Freisenger indices, history of smoking, diabetes, previous myocardial infarction, age and sex. (Adjusted Difference of LVEF=8.2, 95% CI 2.6–13.8). In conclusion we did not find a significant correlation between plasma HCS and extent of CAD as assessed angiographically using proximal and diffuse indices. The data demonstrate that B12 def pts (with elevated HCS levels) had significantly lower LVEF than non B12 def pts. Whether low LVEF results in malabsorption of Vitamin B12 and B12 def or, conversely, whether B12 def and its marker, ie, elevated HCS, depress LVEF, warrants further investigation