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. 2025 Jun 1;32(6):734-752.
doi: 10.5551/jat.65083. Epub 2024 Dec 10.

High Plasma Levels of S-adenosylhomocysteine is Related with the Risk of All-cause and Cardiovascular Mortality in Patients with Coronary Artery Disease

Si Liu  1 , Yongyi Wang  1 , Mengfeng Yang  2 , Xin Dai  1 , Ting Huang  1 , Ruyi Liao  1 , Hengliang Song  1 , Peng Li  1 , Yun Chen  1 , Haiyan Huang  3 , Changhua Zhang  4   5 , Yunjun Xiao  1   5
Affiliations

High Plasma Levels of S-adenosylhomocysteine is Related with the Risk of All-cause and Cardiovascular Mortality in Patients with Coronary Artery Disease

Si Liu et al. J Atheroscler Thromb. .

Abstract

Aims: Plasma S-adenosylhomocysteine (SAH) level is positively associated with cardiovascular risk. However, the relationship between plasma SAH levels and the risk of all-cause and cardiovascular mortality remains unknown. This study aimed to explore the relationship between plasma SAH levels and the risk of all-cause and cardiovascular mortality in patients with coronary artery disease (CAD).

Methods: Plasma SAH levels were measured in 1553 patients with CAD. The association between plasma SAH level and the risk of all-cause and cardiovascular mortality was estimated using Cox Proportional hazards regression models.

Results: Relative to participants in the lowest quartile of plasma SAH levels, those in the highest quartile of plasma SAH levels had a higher risk of all-cause death (adjusted Hazard Ratio [HR], 2.15; 95% CI, 1.54-3.01; P＜0.001) and cardiovascular death (adjusted HR, 2.20; 95% CI, 1.49-3.25; P=0.001) in the age- and sex-adjusted model. The results of the multivariable adjusted analysis were similar (all-cause death [adjusted HR, 1.81; 95% CI, 1.27-2.58; P=0.002] and cardiovascular death [adjusted HR, 1.84; 95% CI, 1.21-2.79; P=0.031]). The age- and sex-adjusted HRs for each 1 SD increase in plasma SAH level were 1.30 (95% CI, 1.22-1.38) for all-cause mortality, and 1.34 (95% CI, 1.25-1.43) for cardiovascular mortality, respectively. A 1 SD increase in the SAH level was associated with a 25% higher risk of total death (adjusted HR, 1.25; 95% CI, 1.17-1.34) and a 29% greater risk of cardiovascular death (adjusted HR, 1.29; 95% CI, 1.20-1.39) in multivariable adjusted analysis.

Conclusions: We found that the plasma SAH level is positively correlated with the risk of all-cause and cardiovascular mortality in patients with CAD in both age- and sex-adjusted and multivariable-adjusted models.

Keywords: Cardiovascular; Coronary artery disease; Homocysteine; Mortality; S-adenosylhomocysteine.

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Conflict of interest statement

None of the authors have any conflicts of interest to declare.

Figures

Fig.1. Methionine and one-carbon metabolism
Fig.1. Methionine and one-carbon metabolism
Met, methionine; MAT, methionine adenosyltransferase enzyme; SAM, S-adenosylmethionine; X, indicates DNA, RNA, histones or other proteins; MTFs, various methyltransferases; SAH, S-adenosylhomocysteine; SAHH, SAH hydrolase; Hcy, homocysteine; BHMT, betaine-Hcy S-methyltransferase; DMG, dimethylglycine; THF, tetrahydrofolate; MTHFR, methylene-THF reductase; MetS, Met synthase.
Supplementary Fig.1. The flow chart of participants through the study
Supplementary Fig.1. The flow chart of participants through the study
CAD, coronary artery disease; GPCDC, Guangdong Provincial Centers for Disease Control and Prevention system; SAH, S-adenosylhomocysteine
Fig.2. Competing risk analyses of the associations between SAH quartiles and the risk of cardiovascular or non-cardiovascular mortality in patients with CAD The cutoff points of the SAH quartiles were 10.74, 17.77, and 27.49 nmol/L
Fig.2. Competing risk analyses of the associations between SAH quartiles and the risk of cardiovascular or non-cardiovascular mortality in patients with CAD The cutoff points of the SAH quartiles were 10.74, 17.77, and 27.49 nmol/L
SAH, S-adenosylhomocysteine.
Fig.3. Multivariable-adjusted spline functions demonstrate the relationship between plasma SAH and all-cause (A) and cardiovascular mortality (B)
Fig.3. Multivariable-adjusted spline functions demonstrate the relationship between plasma SAH and all-cause (A) and cardiovascular mortality (B)
HRs and 95% CIs were estimated using Cox proportional hazards regression models (n=1553). SAH, S-adenosylhomocysteine.
See this image and copyright information in PMC

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