ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1624847
Correlation of homocysteine with the risk of all-cause mortality in patients with coronary heart disease
Provisionally accepted
- 1Heilongjiang University of Chinese Medicine, Harbin, China
- 2The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- 3The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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Objective: This study aimed to confirm the correlation between homocysteine and all-cause mortality in patients with coronary heart disease (CHD) and to provide new clues and theoretical basis for the improvement of poor prognosis and the development of preventive measures in CHD.Methods: This single-center retrospective cohort study included 660 patients with CHD. The association between homocysteine and all-cause mortality was assessed using Cox regression analyses, subgroup analyses, sensitivity analyses, receiver operating characteristic curve (ROC), and Kaplan-Meier survival curve.Results: During a median follow-up time of 45.7 months, 81 all-cause mortality (12%) occurred.Multivariate Cox regression analysis indicated that homocysteine levels were significantly associated with all-cause mortality after adjusting for common confounding factors. Each unit increase and one standard deviation increase in homocysteine levels were associated with a 1% and 15.1% increase in all-cause mortality risk, respectively (HR 1.010, 95% CI 1.001-1.019, P = 0.038; HR 1.151, 95% CI 1.007-1.314, P = 0.038). Subgroup analysis showed that the risk of all-cause mortality significantly increased with rising homocysteine levels across multiple subgroups (P < 0.05). Sensitivity analysis showed that after excluding patients with chronic kidney disease, atrial fibrillation, prior percutaneous coronary intervention, and myocardial infarction, the multivariable Cox regression analysis still confirmed the robust association between higher homocysteine levels and higher risk of all-cause mortality (P < 0.05). ROC analysis showed that homocysteine had a predictive value for the occurrence of all-cause mortality (AUC 0.660, 95% CI 0.595-0.726, P < 0.001). The Kaplan-Meier survival curve showed that the cumulative risk of all-cause mortality significantly differed between homocysteine groups (Log-rank P < 0.001).Higher levels of homocysteine are significantly associated with a higher risk of all-cause mortality in patients with CHD. This suggests that homocysteine evaluation should be considered in the risk monitoring and prognosis assessment for CHD.
Keywords: Homocysteine, coronary heart disease, All-cause mortality, subgroup analysis, sensitivity analysis
Received: 19 May 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Wang, Li, Gao and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tianyi Wang, Heilongjiang University of Chinese Medicine, Harbin, China
Hongting Zhang, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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