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Screening of plasma homocysteine in peripheral arterial disease
R Loncar1, V Hrboka, V Tabakovic-Loncar
1Institut für Hämostaseologie und Transfusionsmedizin, Heinrich-Heine University Düsseldorf, Germany.
Insights
Elevated homocysteine (HCY) is linked to peripheral arterial disease (PAD). While higher HCY levels were found in PAD patients, total plasma HCY is not ideal for general population screening but useful for monitoring specific risk groups.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Clinical Diagnostics
Background:
- Homocysteine (HCY) is an established independent risk factor for atherosclerosis.
- Elevated plasma HCY concentrations are prevalent in patients with arterial occlusive diseases.
Purpose of the Study:
- To evaluate if total plasma HCY concentration serves as a screening marker for peripheral arterial disease (PAD) in the general population.
- To investigate the relationship between HCY levels and PAD.
Main Methods:
- Study included 40 patients with symptomatic lower limb PAD and 40 healthy controls.
- Plasma HCY concentration was measured using derivatization and fluorescence high-performance liquid chromatography.
- Demographic data (age, gender) and PAD status were recorded.
Main Results:
- Total plasma HCY was significantly higher in the PAD group (14.90 +/- 5.78 microM) compared to controls (11.32 +/- 2.95 microM).
- Higher interindividual variability in plasma HCY was observed in the PAD group.
- Plasma HCY levels were influenced by PAD status, gender, and age, with sensitivity and specificity of 0.3 and 0.95, respectively, for PAD detection.
Conclusions:
- HCY metabolism may contribute to PAD development in a subset of patients.
- Total plasma HCY concentration is not suitable as a general screening test for PAD.
- Plasma HCY is more appropriate as a monitoring marker for specific patient risk groups.
Background:
Homocysteine (HCY) was recently established as an independent risk factor for atherosclerosis. The prevalence of an increased homocysteine plasma concentration was reported to be up to 6-fold higher in patients with different locations of arterial occlusive diseases.
Aim:
This study evaluated critically whether the total HCY plasma concentration can be used as a screening marker for peripheral arterial disease in the general population.
Methods:
Study subjects were 40 patients (51.8 +/- 7.5 years) with symptomatic lower limb peripheral arterial disease (PAD) (stage II) and 40 healthy volunteers (45.6 +/- 6.8 years, P< 0.05 vs PAD). The percentage of women in both groups was 30%. The plasma HCY concentration was determined by using derivatization techniques and subsequent fluorescence high-performance liquid chromatography.
Results:
Total plasma HCY concentration was significantly higher in the PAD group than in controls (14.90 +/- 5.78 microM vs 11.32 +/- 2.95 microM, respectively, P< 0.001). Also, the coefficient of variation of plasma HCY in PAD was significantly higher than that in the control group, 0.38 vs 0.25 (P< 0.001), respectively, reflecting greater interindividual differences. In addition to a PAD-specific effect, the plasma HCY concentration was also dependent on gender and age (both P< 0.05). Sensitivity and specificity of HCY as a marker of PAD were 0.3 and 0.95, respectively. Positive and negative predictive values were 0.85 and 0.42, respectively.
Conclusions:
From these data it is concluded that HCY metabolism may have an influence on the development of PAD in one-third of all patients with PAD, and that total plasma HCY concentration may not be suited as a screening test for PAD in the general population but rather serves as a monitoring marker in certain risk groups.