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[Homocysteine and cardiovascular disease: what is the connection?]
J Blacher1, P Ducimetière, M Safar
1Service de Médecine Interne-Thérapeutique, INSERM Unité 337, Hôpital Broussais, Paris. jacques.blacher@brs.ap-hop-paris.fr
Insights
High homocysteine levels are linked to increased cardiovascular disease risk, but vitamin B supplementation
Area of Science:
- Cardiovascular Science
- Metabolic Research
Context:
- Elevated homocysteine is implicated in atherosclerosis and cardiovascular disease (CVD).
- Observational studies show a correlation between high homocysteine and increased CVD risk, including coronary artery disease, stroke, and peripheral vascular disease.
- However, findings are inconsistent, with some studies not supporting homocysteine as an independent CVD risk factor.
Purpose:
- To review the evidence for homocysteine as a cardiovascular risk factor.
- To explore the potential of vitamin B supplementation for CVD prevention.
- To identify research gaps and recommend future study designs.
Summary:
- Experimental data suggest homocysteine plays a role in atherosclerosis.
- Prospective studies indicate high homocysteine levels are associated with higher CVD risk, though this is not universally confirmed.
- Dietary vitamin B supplementation effectively lowers homocysteine but lacks definitive proof of CVD risk reduction from clinical trials.
Impact:
- Highlights the need for further research to clarify homocysteine's role in CVD.
- Emphasizes the importance of interventional trials over observational studies for definitive conclusions.
- Suggests large-scale pragmatic studies on vitamin B supplementation are required to determine its preventive efficacy against cardiovascular disease.
Abstract:
HYPERHOMOCYSTEINEMIA: There are experimental data arguing for a role of homocysteine in several processes involved in atherosclerosis. Multiple retrospective and prospective studies performed in populations with high cardiovascular risk have shown that high homocysteine levels are associated with increased risk of coronary artery disease, stroke and peripheral vascular disease. In populations free of cardiovascular disease, prospective studies have demonstrated that homocysteine is a risk factor for cardiovascular disease while in other publications, no such prognostic value is found for high serum levels of homocysteine. PERSPECTIVE AND PREVENTION: There are highly promising perspectives for prevention due to the fact that serum homocysteine levels fall off systematically after simple dietary supplementation with vitamin B. Nevertheless, there is no formal proof to date from therapeutic trials suggesting that such a supplementation would reduce the risk of cardiovascular disease. FURTHER INFORMATION REQUIRED: In terms of epidemiology and clinical expression, further research into homocysteine as a cardiovascular risk factor should not be based on case-control studies which can be expected to provide information of limited usefulness, but rather on interventional trials to determine the primary or secondary preventive effect on cardiovascular disease. A large-scale pragmatic study using diet supplementation in a wide population might provide answers to still open questions.