The association between lifestyle-related factors and plasma homocysteine levels in healthy individuals from the “ATTICA” Study

Objective: The aim of this work was to investigate the associations between homocysteine levels and several lifestyle-related factors, in a population-based sample of Greek adults. Methods: During 2001-2002, we randomly enrolled 1128 men and 1154 women, from Athens area. The sampling was stratified by the age-gender distribution of the underlying population. Among several demographic, lifestyle, clinical and biochemical factors, we measured plasma total homocysteine levels. For the present analysis, we excluded people who had a history of cardiovascular disease. Results: Homocysteine values were higher in men as compared to women (14.5±6 vs. 10.8±3.5 μmol/l, p<0.001). Twenty-five percent of men and 15% of women had plasma homocysteine levels >14 μmol/l. Postmenopausal women had higher homocysteine levels (12.0±5.2 vs. 9.9±2.9 μmol/l, p<0.001). The lifestyle factors most strongly associated with plasma total homocysteine were number of cigarettes smoked (r=0.12, p=0.004), fruits (r=−0.12, p=0.006) and vegetables consumption (r=−0.15, p=0.02), alcohol (r=0.11, p=0.04) and coffee drinking (r=0.10, p=0.03). Additionally, aerobic exercise was related with lower homocysteine levels as compared to anaerobic or sedentary life (11.0±2.6 vs. 12.4±2.5 vs. 12.5±2.3 μmol/l, respectively, p=0.04). Multivariate analysis after adjusting for several potential confounders confirmed the previous associations. No relationship was observed of homocysteine with the Mediterranean diet score (r=0.02, p=0.85). Conclusions: Several lifestyle-related factors were associated with homocysteine levels. Identifying and understanding modifiable factors related to homocysteine, a possible risk factor for vascular disease, might be especially important for the public health.