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Plasma homocysteine levels in acute coronary syndromes
1Department of Clinical Biochemistry, Ege University School of Medicine, Izmir, Turkey.
Insights
Elevated homocysteine levels, a condition known as hyperhomocysteinemia, are significantly higher in patients with acute coronary syndromes. This finding supports homocysteine as an independent risk factor for cardiovascular diseases, independent of traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Biochemistry
Background:
- Hyperhomocysteinemia is recognized as an independent, modifiable risk factor for ischemic vascular diseases and thrombosis.
- Elevated homocysteine levels may contribute to the complex pathophysiology of ischemic heart disease.
Purpose of the Study:
- To investigate fasting plasma total homocysteine levels in patients with acute coronary syndromes compared to control subjects.
- To explore the association of homocysteine levels with classical risk factors and vitamin status.
Main Methods:
- Fasting plasma total homocysteine was measured using HPLC with fluorescence detection.
- Demographic data, classical risk factors, lifestyle habits, lipid profiles, and vitamin levels (B12, folate) were assessed.
- Comparison between 30 patients with acute coronary syndromes and 30 matched controls.
Main Results:
- Patients with acute coronary syndromes exhibited significantly higher total homocysteine concentrations (12.2 micromol/l) than controls (7.05 micromol/l; p < 0.0001).
- Homocysteine levels correlated positively with age and serum creatinine in the patient group.
- No significant differences were found in vitamin B12, folate levels, or lipid parameters between patients and controls.
Conclusions:
- Hyperhomocysteinemia is confirmed as an independent risk factor for cardiovascular diseases, particularly in acute coronary syndromes.
- Elevated homocysteine is a significant factor in the multifactorial pathophysiology of ischemic heart disease.
- The findings underscore the importance of homocysteine as a risk marker beyond traditional cardiovascular risk factors.
Abstract:
Hyperhomocysteinemia is currently regarded as an independent and modifiable risk factor for ischemic vascular diseases and thrombosis. We measured fasting plasma total homocysteine levels by HPLC with fluorescence detection in 30 patients presenting with acute coronary syndromes and 30 age and sex-matched control subjects. Demographic data, classical risk factors (systolic blood pressure, diabetes mellitus, smoking, ethanol intake, family history of ischaemic heart disease) and life-style habits were recorded. Lipid fractions including total cholesterol, triglycerides, HDL-cholesterol, total cholesterol/HDL-cholesterol ratio, serum creatinine, LDL-cholesterol and vitamins involved in the metabolism of homocysteine, folic acid and vitamin B12 were also assessed. Total fasting homocysteine concentrations were significantly higher in the patient group (12.2 +/- 1.01 micromol/l) than in the control subjects (7.05 +/- 0.36 micromol/l; p < 0.0001). Homocysteine correlated positively with age (r = 0.617; p < 0.01) and serum creatinine (r = 0.457; p < 0.01) in the patient group. Hyperhomocysteinemia was not associated with vitamin B12 or folate deficiency states. Vitamin B12 concentration was 273 +/- 16.4 ng/l in the control group and 284.3 +/- 32.2 ng/l in the patient group (p = NS). Serum folate concentration also was not significantly different between controls and patients; 7.57 +/- 0.58 microg/l and 8.05 +/- 0.72 microg/l, respectively. Since no significant difference was observed in the lipid parameters between patients and controls, the hyperhomocysteinemia in the patient group supports the view that homocysteine is an independent risk factor for cardiovascular diseases. Our results strongly suggest that elevated homocysteine levels are among the interacting factors in the complex, multifactorial pathophysiology of ischemic heart disease.