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Hyperhomocysteinaemia is not associated with isolated crural arterial occlusive disease: The Hoorn Study
E K Hoogeveen1, P J Kostense, C Jakobs
1Institute for Research in Extramural Medicine, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. ellenhgv@casema.net
Insights
Hyperhomocysteinemia is linked to aortoiliac arterial occlusive disease, but not isolated crural disease. This finding is crucial for understanding peripheral arterial disease prognosis based on obstruction location.
Area of Science:
- Vascular Medicine
- Biochemistry
- Epidemiology
Background:
- Hyperhomocysteinemia is a known risk factor for peripheral arterial disease (PAD).
- The anatomical location of PAD significantly impacts patient prognosis, with proximal disease (aortoiliac, femoropopliteal) having a poorer outlook than isolated distal (crural) disease.
- Understanding the relationship between hyperhomocysteinemia and PAD localization is critical for risk stratification.
Purpose of the Study:
- To investigate if the association between hyperhomocysteinemia and peripheral arterial disease varies by the location of arterial obstruction.
- To determine if hyperhomocysteinemia is specifically linked to proximal versus distal PAD.
Main Methods:
- Fasting serum total homocysteine (tHcy) levels were measured in 631 individuals aged 50-75.
- Peripheral arterial obstructions (aortoiliac, femoropopliteal, crural) were identified using Doppler flow velocity curves.
- Statistical analysis adjusted for age, sex, blood pressure, smoking, cholesterol, and diabetes.
Main Results:
- An increased risk of aortoiliac obstruction was associated with higher tHcy levels (OR 1.41 per 5 micromol/L increment).
- No significant association was found between tHcy levels and femoropopliteal (OR 1.03) or crural (OR 0.82) obstructions.
- Diabetes, HbA1c, and smoking were linked to crural and femoropopliteal disease; systolic blood pressure was linked to aortoiliac disease.
Conclusions:
- Hyperhomocysteinemia is significantly associated with aortoiliac arterial occlusive disease.
- The study suggests that hyperhomocysteinemia is not associated with isolated crural arterial occlusive disease.
- These findings highlight the importance of PAD localization in the context of metabolic risk factors.
Objectives:
Hyperhomocysteinaemia is an independent risk factor for peripheral arterial disease (PAD). The localization of peripheral arterial disease is clinically relevant, because proximal (aortoiliac and femoropopliteal) disease is associated with a particularly poor overall prognosis, whereas isolated distal (i.e. crural) disease is associated with a better overall prognosis. The aim of the study was to investigate whether the strength of the association between hyperhomocysteinaemia and peripheral arterial disease differs according to the localization of the anatomical obstruction.
Design:
Fasting serum total homocysteine (tHcy) was measured in an age-, sex- and glucose-tolerance stratified random sample (n = 631) of a 50- to 75-year-old general Caucasian population. History of a peripheral arterial reconstruction was recorded. Aortoiliac, femoropopliteal and crural arterial obstructions were registered by means of Doppler flow velocity curves.
Results:
The median serum tHcy level was 12.2 micromol L-1 (interquartile range: 10.0-15.3) in men and 10.7 micromol L-1 (interquartile range: 9.0-13.3) in women. The prevalences of aortoiliac, femoropopliteal and crural obstructions were 2.1%, 2.7% and 11.9%, respectively. After adjustment for age, sex, systolic blood pressure, current smoking, serum cholesterol and diabetes mellitus, the odds ratios (95% confidence interval) per 5 micromol L-1 tHcy increment were 1.41 (1.05-1.89) for aortoiliac, 1.03 (0. 70-1.52) for femoropopliteal and 0.82 (0.59-1.15) for crural obstructions. Finally, diabetes mellitus, HbA1c and current smoking were significantly associated with crural and femoropopliteal disease, whereas systolic blood pressure was significantly associated with aortoiliac obstructions.
Conclusions:
The present study indicates that hyperhomocysteinaemia is associated with aortoiliac but not with isolated crural arterial occlusive disease.
