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.