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Hyperhomocysteinemia and thrombosis
S C Guba1, V Fonseca, L M Fink
1Department of Medicine, University of Arkansas for Medical Sciences and the Little Rock VAMC, USA. scguba@ibm.net
Insights
Homocysteine is a risk factor for vascular occlusive disease (VOD). While the link is clear in severe cases, mild to moderate hyperhomocysteinemia
Area of Science:
- Cardiovascular Science
- Thrombosis Research
- Metabolic Disease
Background:
- Homocysteine is an independent risk factor for atherosclerotic and thrombotic diseases.
- Hyperhomocysteinemia is associated with both arterial and veno-occlusive diseases (VOD).
- The association is clear in homocystinuria but controversial in mild to moderate hyperhomocysteinemia due to multiple etiologies.
Purpose of the Study:
- To review studies supporting or refuting homocysteine as an independent risk factor for VOD.
- To explore the complexities in studying the homocysteine-VOD relationship.
- To highlight ongoing research in homocysteine and thrombosis.
Main Methods:
- Review of existing scientific literature.
- Analysis of studies investigating the link between homocysteine levels and vascular occlusive disease.
- Examination of factors influencing homocysteine levels and VOD etiology.
Main Results:
- Clear association between homocysteine and VOD in severe hyperhomocysteinemia (homocystinuria).
- Controversy persists regarding the role of mild to moderate hyperhomocysteinemia in VOD.
- Multiple contributing factors complicate controlled studies.
Conclusions:
- The relationship between homocysteine and VOD is complex and multifactorial.
- Further research is needed to clarify homocysteine's role as an independent risk factor.
- Homocysteine and thrombosis research remains an active and evolving field.
Abstract:
Homocysteine has been identified as an independent risk factor for atherosclerotic and thrombotic disease. Both arterial (cerebrovascular, carotid, coronary, and peripheral arterial) and veno-occlusive disease, jointly termed vascular occlusive disease (VOD) in this review, have been associated with hyperhomocysteinemia. In cases of homocystinuria, plasma homocysteine levels are markedly elevated. In this setting, the association between homocysteine and VOD seems clear. However, in cases of mild to moderate homocysteinemia, controversy remains regarding the association between homocysteine and VOD. In part this controversy occurs because VOD has multiple etiologies. Similarly, homocysteine levels are affected by several factors including vitamin status, age and gender, and genotype of the patient. The multiple etiologies of both VOD and hyperhomocysteinemia make controlled studies assessing their interrelationship difficult to perform. This review will attempt to present studies that either support or rebut homocysteine as an independent risk factor for vascular occlusive disease and will show that the study of homocysteine and thrombosis remains an active area of research.