{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:20:37Z","timestamp":1788276037335,"version":"build-2803163510"},"reference-count":69,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Elevated levels of serum homocysteine, via impaired nitric oxide production, and coronary microvascular dysfunction are associated with increased risk of major adverse cardiovascular events. However, whether serum homocysteine levels and coronary microvascular endothelial dysfunction (CMED) are linked remains unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This study included 1418 patients with chest pain or an abnormal functional stress test and with nonobstructive coronary artery disease (&lt;40% angiographic stenosis), who underwent CMED evaluation with functional angiography and had serum homocysteine levels measured. Patients were classified as having normal microvascular function versus CMED. Patients in the CMED group (n=743; 52%) had higher mean age (52.1\u00b112.2 versus 50.0\u00b112.4\u00a0years;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), higher body mass index (29.1 [25.0\u201332.8] versus 27.5 [24.2\u201332.4];\n              <jats:italic>P<\/jats:italic>\n              =0.001), diabetes mellitus (12.5% versus 9.4%;\n              <jats:italic>P<\/jats:italic>\n              =0.03), and fewer women (63.5% versus 68.7%;\n              <jats:italic>P<\/jats:italic>\n              =0.04) compared with patients in the normal microvascular function group. However, they had lower rates of smoking history, and mildly lower low\u2010density lipoprotein cholesterol levels. Serum homocysteine levels were significantly higher in patients with CMED, and the highest quartile of serum homocysteine level (&gt;9\u00a0\u00b5mol\/L) was an independent predictor of CMED (odds ratio, 1.34 [95% CI, 1.03\u20131.75];\n              <jats:italic>P<\/jats:italic>\n              =0.03) after adjustment for age; sex; body mass index; chronic kidney disease (CKD); diabetes mellitus; smoking exposure; low\u2010density lipoprotein cholesterol; high\u2010density lipoprotein cholesterol and triglycerides; and aspirin, statin, and B vitamin use.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with CMED have significantly higher levels of serum homocysteine. Elevated serum homocysteine levels were associated with a significantly increased odds of an invasive diagnosis of CMED. The current study supports a potential role for homocysteine for diagnosis and target treatment in the patients with early coronary atherosclerosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.017746","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T08:56:30Z","timestamp":1601456190000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Coronary Microvascular Endothelial Dysfunction in Patients With Angina and Nonobstructive Coronary Artery Disease Is Associated With Elevated Serum Homocysteine Levels"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9669-8009","authenticated-orcid":false,"given":"Ali","family":"Ahmad","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6443-2345","authenticated-orcid":false,"given":"Michel T.","family":"Corban","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Toya","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"},{"name":"Division of Cardiology National Defense Medical College Tokorozawa Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaskanwal D.","family":"Sara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5176-1761","authenticated-orcid":false,"given":"Ben","family":"Lerman","sequence":"additional","affiliation":[{"name":"School of Medicine St. George\u2019s University West Indies Grenada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Young","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"},{"name":"Division of Cardiology Department of Internal Medicine Nowon Eulji Medical Center Eulji University Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3271-3887","authenticated-orcid":false,"given":"Lilach O.","family":"Lerman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-5313","authenticated-orcid":false,"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr331"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907272"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.06.017"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mca.0000134590.99841.81"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs246"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2014.12.008"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-6175.2004.03254.x"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.01.054"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.10.3369"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000153339.27064.14"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.07.059"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.07.012"},{"key":"e_1_3_1_14_2","first-page":"387","article-title":"Association of coronary microvascular endothelial dysfunction with vulnerable plaque characteristics in early coronary atherosclerosis","author":"Godo S","year":"2019","unstructured":"Godo S, Corban MT, Toya T, Gulati R, Lerman LO, Lerman A. 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