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Diagnosis and treatment of hyperhomocysteinemia
M E Keebler1, C De Souza, V Fonseca
1Section of Endocrinology, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue (SL 53), New Orleans, LA 70112, USA.
Insights
High homocysteine levels are a risk factor for cardiovascular disease. Vitamin therapy, like folic acid, lowers homocysteine and improves vascular health markers, guiding clinical practice.
Area of Science:
- Cardiovascular Medicine
- Clinical Nutrition
- Biochemistry
Background:
- Hyperhomocysteinemia is a recognized risk factor for cardiovascular disease (CVD).
- The clinical utility of treating hyperhomocysteinemia is debated due to limited evidence from cardiovascular event-driven trials.
- Elevated homocysteine levels impact endothelial function and other CVD risk markers.
Purpose of the Study:
- To review the role of hyperhomocysteinemia in cardiovascular disease.
- To evaluate the impact of vitamin therapy on homocysteine levels and surrogate CVD risk markers.
- To propose a practical clinical algorithm for managing hyperhomocysteinemia.
Main Methods:
- Literature review of clinical studies on hyperhomocysteinemia and cardiovascular risk.
- Analysis of data regarding the efficacy of vitamin therapy (specifically folic acid) on plasma homocysteine.
- Assessment of vitamin therapy's effects on surrogate markers like endothelial function.
Main Results:
- Vitamin therapy, particularly folic acid, effectively reduces plasma homocysteine levels.
- Folic acid supplementation improves endothelial function and other surrogate markers of cardiovascular risk.
- Existing clinical data supports a therapeutic approach despite the absence of definitive cardiovascular outcome trials.
Conclusions:
- Vitamin therapy offers a viable strategy to manage hyperhomocysteinemia and mitigate associated cardiovascular risks.
- An evidence-based algorithm can guide clinicians in the diagnosis and treatment of hyperhomocysteinemia.
- Further clinical trials are needed to confirm the definitive benefit of homocysteine-lowering therapies on cardiovascular events.
Abstract:
Hyperhomocysteinemia has emerged as an important risk factor for cardiovascular disease. However, its place in clinical practice is somewhat unclear, due to the lack of clinical trials documenting the benefit of treatment on reducing cardiovascular events. Vitamin therapy, particularly with folic acid, reduces plasma homocysteine significantly and improves other surrogate markers of cardiovascular risk such as endothelial function. Although a consensus is lacking on the right approach to diagnosis and treatment of this risk factor, we have suggested an algorithm based on data from clinical studies. We are optimistic that such an approach will be helpful for the clinician until clinical trials, with cardiovascular events as endpoints, are completed.