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Relationships between serum hyperhomocysteinemia and carotid atherosclerosis in geriatric patients
Insights
Elevated serum total homocysteine (tHCY) levels are linked to more severe carotid atherosclerosis. Moderate hyperhomocysteinemia significantly increases the risk of high thromboembolic risk carotid lesions.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Chemistry
Background:
- Serum total homocysteine (tHCY) is a potential risk factor for cardiovascular diseases.
- Carotid atherosclerosis is a significant contributor to cerebrovascular events.
Purpose of the Study:
- To investigate the association between serum total homocysteine levels and the severity of carotid atherosclerosis.
- To determine if hyperhomocysteinemia correlates with a higher risk of thromboembolic events in patients with carotid lesions.
Main Methods:
- 102 patients over 65 underwent high-resolution echo-Doppler and Doppler cw examination of epiaortic vessels.
- Patients were categorized into high and low thromboembolic risk groups based on carotid plaque characteristics and stenosis.
- Serum tHCY levels were quantified using immunofluorescent assay (FPIA) and patients were grouped by normal, mild, or moderate hyperhomocysteinemia.
Main Results:
- Patients with mild and moderate hyperhomocysteinemia showed a significantly greater prevalence of high thromboembolic risk carotid lesions compared to those with normal tHCY.
- Moderate hyperhomocysteinemia was strongly associated with high-risk carotid lesions (Odds Ratio = 4.6).
- No significant differences in age, gender, or common cardiovascular risk factors were observed across the tHCY groups.
Conclusions:
- Hyperhomocysteinemia is associated with severe carotid lesions that carry a higher risk of cerebrovascular events.
- Elevated tHCY levels, particularly moderate hyperhomocysteinemia, are a significant risk factor for adverse carotid plaque phenotypes.
Background:
Evaluate the relationships between serum total hyperhomocysteinemia and carotid atherosclerosis.
Methods:
The 102 consecutive patients over the age of 65 epiaortic vessels were examined by means of a high-resolution echo-Doppler and Doppler cw. Depending on the size of the atherosclerotic plaques in the carotid the patients were divided into two groups: a) patients with lesions at high thromboembolic risk (heterogeneous and/or ulcerated plaques, hemodynamically significant stenoses > 70%); b) individuals with low risk carotid involvement (IMT normal and/or thickened by > 0.8 mm and/or lumen stenosed by homogeneous plaques < 70%). The quantitative assay of serum total homocysteinemia (tHCY) was carried out by means of an immunofluorescent method (FPIA). Depending on their tHCY values, the patients were broken down into those with normal tHCY (cut-off 14 mumol/l for the women and 16 mumol/l for the men; 62 patients, M/F = 34/28, mean age 71 +/- 4); patients with mild hyperhomocysteinemia (tHCY 14-18 mumol/l for the women; 16-20 mumol/l for the men; 19 patients, M/F = 11/8; mean age 74 +/- 7); patients with moderate hyperhomocysteinemia tHCY 18 mumol/l for the women; > 20 mumol/l for the men; 21 patients, M/F = 18/3; mean age 74 +/- 7).
Results:
As against the individuals with normal serum concentrations of HCY (Fig. 2; chi 2: p < 0.05), the patients with mild hyperhomocysteinemia (Odds ratio: OR = 1.48) and, above all, patients with moderate hyperhomocysteinemia (OR = 4.6) were found to have a greater prevalence of carotid lesions at high thromboembolic risk. No significant differences within the three groups were found with regard to distribution by age, gender and the prevalence of the more common cardiovascular risk factors (smoking, diabetes mellitus, arterial hypertension, hyperdyslipidemia).
Conclusions:
Hyperhomocysteinemia is associated with highly severe carotid lesions at higher risk for cerebrovascular events.