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[Homocysteine. The cardiovascular risk factor of the next millennium?]
I Suárez García1, J F Gómez Cerezo, J J Ríos Blanco
1Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid.
Insights
High homocysteine levels (hyperhomocysteinemia) are linked to arterial and venous diseases. Nutritional supplements may lower homocysteine, but more research is needed to confirm reduced cardiovascular risk.
Area of Science:
- Cardiovascular Epidemiology
- Metabolic Disorders
- Vascular Biology
Context:
- Epidemiologic studies link elevated homocysteine to arteriosclerosis across major arteries.
- This association appears independent of other cardiovascular risk factors and shows a dose-response relationship.
- Contradictory findings exist in prospective studies, and hyperhomocysteinemia is also associated with venous thrombosis risk.
Purpose:
- To review the association between hyperhomocysteinemia and cardiovascular and venous diseases.
- To discuss the causes of hyperhomocysteinemia, including genetic and nutritional factors.
- To evaluate the potential of vitamin supplementation in managing homocysteine levels and associated risks.
Summary:
- Hyperhomocysteinemia is a recognized risk factor for arteriosclerosis in coronary, cerebral, peripheral, and aortic arteries, independent of other risk factors.
- The condition is also linked to an increased risk of venous thrombosis, potentially interacting with other coagulation disorders.
- Causes include genetic defects and nutritional deficiencies (vitamins B6, B12, folic acid), which can be addressed by dietary supplements.
- While supplements lower plasma homocysteine, randomized clinical trials are necessary to confirm a reduction in cardiovascular disease risk.
Impact:
- Highlights hyperhomocysteinemia as a significant, independent risk factor for arterial disease.
- Identifies nutritional deficiencies as a modifiable cause of hyperhomocysteinemia.
- Emphasizes the need for further clinical trials to validate therapeutic interventions for reducing cardiovascular risk by lowering homocysteine levels.
Abstract:
Several epidemiologic studies have demonstrated that hyperhomocysteinemia is a risk factor for arteriosclerosis in coronary, cerebral, peripheral and aortic arteries. This risk is independent of other cardiovascular risk factors, and it is dose related. However, prospective studies show contradictory findings. Hyperhomocysteinemia is also associated with a higher risk of venous thrombosis to which other coagulation disorders, such as factor V Leiden, could contribute. Hyperhomocysteinemia can be due to genetic defects in the enzymes that control homocysteine metabolism, and also to other factors, mainly nutritional (deficiencies in vitamin B6, vitamin B12, or folic acid). Dietary supplements of these vitamins reduce plasma homocysteine levels. Randomized clinical trials are still needed to demonstrate that reducing plasma homocysteine levels will reduce the risk for cardiovascular disease.