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Homocyst(e)ine and atherosclerosis in patients on chronic hemodialysis
1Department of Internal Medicine, College of Medicine, Korea University, Seoul.
Insights
High homocysteine levels (above 24.4 micromol/L) are a significant, modifiable risk factor for cardiovascular disease in hemodialysis patients. This finding holds true regardless of patient age.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Hyperhomocysteinemia is a known risk factor for atherosclerosis.
- Cardiovascular disease (CVD) is a major concern for patients undergoing chronic hemodialysis.
Purpose of the Study:
- To identify variables and risk factors for atherosclerosis, measured by atherosclerotic score (AS).
- To determine the relative risk for CVD in relation to plasma homocysteine levels in hemodialysis patients.
Main Methods:
- Evaluated 61 chronic hemodialysis patients for clinical and biochemical parameters, including AS and plasma homocysteine.
- Compared patient groups divided by mean AS and median plasma homocysteine levels.
- Utilized multivariate analysis to identify significant risk factors.
Main Results:
- AS significantly correlated with plasma homocysteine (r=0.37) and age (r=0.67).
- Plasma homocysteine and age were significant risk factors for high AS (p<0.05).
- High homocysteine levels (>24.4 micromol/L) were associated with a 9.3-fold increased odds of CVD.
Conclusions:
- Hyperhomocysteinemia, particularly levels >24.4 micromol/L, is a modifiable risk factor for CVD in hemodialysis patients.
- Elevated homocysteine is an independent risk factor for CVD in this population, irrespective of age.
Abstract:
Hyperhomocyst(e)inemia is an established risk factor for atherosclerosis. We performed this study to identify the correlating variables and risk factors for atherosclerosis, as measured by the atherosclerotic score (AS), and to determine the relative risk for cardiovascular disease in relation to plasma homocyst(e)ine levels in patients on chronic hemodialysis. We evaluated and measured 61 patients on chronic hemodialysis for clinical and biochemical parameters including atherosclerotic score (AS) and plasma homocyst(e)ine. We divided patients into high and low groups, first, by the mean AS, and second, by the median value of plasma total homocyst(e)ine levels. Then we compared the variables between the two groups. Out of the 61 patients, the median plasma total homocyst(e)ine level was 24.4 micromol/L (mean+/-SD, 27.7+/-17.4; range, 9.8-127.4 micromol/L), and the median AS was 5 (mean+/-SD, 6.2+/-2.8; range, 3-13) out of a possible 20 points. AS was significantly correlated with plasma total homocyst(e)ine levels (r=0.37) and age (r=0.67). Through multivariate analysis, plasma total homocyst(e)ine level and age were determined as significant risk factors for the high-AS group (p<0.05). However, plasma total homocyst(e)ine level did not correlate with age (p>0.05). Eighteen of the 61 patients, presented with cardiovascular disease until the present study, had an AS>6. Cardiovascular disease was found more often in the high-homocyst(e)ine group (>24.4 micromol/L) than in the low-homocyst(e)ine group (odds ratio, 9.3; 95% confidence interval, 2.3-37.4). Regardless of age, hyperhomocyst(e)inemia (especially homocyst(e)ine levels >24.4 micromol/L) is a risk factor that can be modified for the development of cardiovascular disease in patients on chronic hemodialysis.