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Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes
M K Al-Obaidi1, P J Stubbs, R Amersey
1National Heart and Lung Institute, Charing Cross Campus, Imperial College School of Medicine, and the Cardiology Department of The Hammersmith Hospitals NHS Trust, London, UK. m.al-obaidi@rbh.nthames.nhs.uk
Insights
Plasma homocysteine levels in acute coronary syndromes are minimally affected by inflammation. Reliable homocysteine measurements can be obtained on admission for patients with myocardial infarction and unstable angina.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Chemistry
Background:
- Elevated plasma homocysteine is a known risk factor for coronary artery disease.
- Patients with myocardial infarction or unstable angina exhibit increased coagulation and troponin release, indicating a worse prognosis.
Purpose of the Study:
- To investigate the relationship between plasma homocysteine concentrations and C-reactive protein (CRP) levels in patients presenting with acute coronary syndromes.
- To assess variations in plasma homocysteine during the acute phase of myocardial infarction and unstable angina.
Main Methods:
- Studied consecutive patients with acute myocardial infarction (n=22) and unstable angina pectoris (n=12).
- Collected plasma samples on admission, days 2, 7, 28, and 6 months post-admission.
- Assayed plasma homocysteine and CRP using high-performance liquid chromatography and measured changes via analysis of variance.
Main Results:
- CRP levels peaked on day 2 and gradually normalized by six months in both patient groups.
- Homocysteine concentrations in myocardial infarction patients showed minimal variation, with significant differences only noted between day 2 and day 7 (p < 0.05).
- Homocysteine levels in unstable angina patients did not significantly differ between admission and convalescence.
Conclusions:
- Plasma homocysteine concentrations are minimally influenced by acute phase inflammatory responses.
- Reliable measurements of plasma homocysteine in patients with myocardial infarction and unstable angina can be obtained upon admission.
Background:
Raised plasma homocysteine is a risk factor for coronary artery disease. Patients with myocardial infarction or unstable angina show greater activation of coagulation, greater troponin release, and a worse outcome.
Objective:
To examine variations in plasma homocysteine concentration in relation to C reactive protein (CRP) in patients presenting with acute coronary syndromes.
Methods:
Consecutive patients presenting with acute myocardial infarction (22) and unstable angina pectoris (12) were studied. Plasma samples were obtained on admission (before clinical intervention), on days 2, 7, and 28, and again six months after admission. Plasma homocysteine, assayed by high performance liquid chromatography, and CRP were both determined at the same time points. Changes were assessed by analysis of variance.
Results:
CRP concentrations showed a classical rise on day 2, followed by a gradual decline to normal values taken at six months from admission in both myocardial infarction (p < 0.0001) and unstable angina (p = 0.02). Homocysteine concentrations in myocardial infarction (median, 25th to 75th interquartile range) were: 11.9 (10.7 to 12.6), 11.5 (9.1 to 13.4), 12.1 (11.4 to 14.1), 12.4 (11.1 to 14.4), and 12.1 (11.2 to 14.0) micromol/l, for days 1, 2, 7, 28, and 180, respectively (p = 0.02). Significant differences were observed only between day 2 and day 7 (p < 0.05). The final homocysteine measurement was not different from the admission level. Homocysteine concentrations in unstable angina did not differ between admission and convalescence (12.5 (9.1 to 14.5) micromol/l and 12.3 (7.7 to 14.9) micromol/l, respectively).
Conclusions:
Plasma homocysteine concentrations are minimally influenced by acute phase variations with reliable measurements obtained on admission in patients with myocardial infarction and unstable angina.