Association between smoking status and homocysteine levels and possible effect modification by cholesterol and oestradiol

Abstract

Introduction: This study aimed to examine the association of smoking status with homocysteine levels and to determine whether the association is modified by oestradiol or cholesterol.

Methods: Data (N = 4580) were obtained from National Health and Nutrition Examination Survey 2003–2004 with analysis done in 2018 on adults aged ≥20 years. The outcome was homocysteine; smoking status was the exposure variable and categorized as current, former or never smoker. Generalized linear models were used to examine the associations between smoking status and homocysteine levels, while assessing the impact of oestradiol and cholesterol.

Results: After adjusting for age, sex, ethnicity, education and income level, homocysteine levels did differ by smoking status ((current smokers versus never smokers: β: 0.18 CI: 0.00, 0.36), (former smokers: β: 0.10 CI: –0.09, 0.28)). The addition of oestradiol as an interaction term in adjusted models was associated with a 16.6% increase in homocysteine levels when compared to models without the interaction term. Oestradiol but not cholesterol did moderate the association between smoking status and homocysteine levels.

Discussion and conclusions: Homocysteine levels did differ across smoking status after adjusting for confounders. Oestradiol did moderate the relationship between homocysteine and smoking status.

Keywords:

• Cardiovascular disease
• environmental pollution/ecotoxicology
• tobacco science
• homocysteine
• oestradiol
• smoking

Author contributions

Ogbebor Omoike was involved in conception and design of the study, data analysis and interpretation, writing and revision of the article for important intellectual content, reading and approval of the final version of the submitted manuscript. Timir Paul was involved with data interpretation, revision of the article for important intellectual content, reading and approving the final version of the submitted manuscript. Stanley Ridner was involved with data interpretation, revision of the article for important intellectual content, reading and approving the final version of the submitted manuscript. Sam Harirforoosh was involved with data interpretation, revision of the article for important intellectual content, reading and approving the final version of the submitted manuscript. Manul Awasthi was involved with data interpretation, writing of the article, reading and approving the final version of the article. Hadii Mamudu was involved with data interpretation, revision of the article for important intellectual content, reading and approving the final version of the submitted manuscript as well as coordinating the entire process.

Disclosure statement

No financial (or nonfinancial) disclosures were reported by the authors of this paper.