Agreement among Four Homocysteine Assays and Results in Patients with Coronary Atherosclerosis and Controls

BACKGROUNDHyperhomocysteinemia has been associated with coronary atherosclerosis in many, but not all, prospective and retrospective studies. Some on these inconsistencies may be attributed to methodological variabilities.METHODSIn the present study, three newly commercially available assays and one in-house HPLC assay for total homocysteine (tHcy) were utilized in 99 subjects with angiographically documented atherosclerosis and in 91 community controls matched by age, gender, and smoking history. The in-house assay, a modified Fortin and Genest HPLC method, was compared with the Bio-Rad HPLC assay, the Abbott IMx((R)) fluorescence polarization immunoassay, and a Bio-Rad enzyme-linked immunoassay (EIA) microtiter method.RESULTSCorrelation coefficient values between the in-house HPLC assay and the Bio-Rad HPLC, the Abbott IMx, and the Bio-Rad EIA assays were 0.95, 0.96 and 0.90, respectively. Although tHcy concentrations were higher in cases compared with controls by all four methods, the difference reached statistical significance only with the in-house HPLC procedure (median, 13.5 +/- 6.7 micromol/L in cases vs 10.9 +/- 4.8 micromol/L in controls; P <0. 01, adjusting for covariates), where it was an independent predictor of case or control status, along with hypertension, total cholesterol, and triglycerides. The tHcy distributions in cases and controls demonstrated significant overlap. The number of atherosclerotic major coronary vessels was associated with significantly higher tHcy (P <0.01 for trend) in all four methods.CONCLUSIONSThe three commercial assays for tHcy differed in analytical and clinical performance. Analytically, the Abbott IMx method showed the best comparability with the in-house assay, but clinically, the three commercial methods were similar and did not distinguish cases from controls.