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Published on: May 7, 2015
Levels of plasma homocysteine in persons with spinal cord injury
W A Bauman1, R H Adkins, A M Spungen
1Spinal Cord Damage Research Center and Department of Medicine, Mount Sinai Medical Center, New York, New York, USA. wabauman@earthlink.net
Insights
Individuals with spinal cord injury (SCI) have higher plasma homocysteine levels, increasing their risk for vascular disease. Older age and male sex are associated with elevated homocysteine in SCI patients.
Area of Science:
- Cardiovascular Science
- Neurology
- Metabolic Science
Background:
- Premature coronary vascular disease is a major cause of death in individuals with chronic spinal cord injury (SCI).
- Elevated plasma homocysteine is an independent risk factor for vascular disease.
Purpose of the Study:
- To compare plasma homocysteine levels in individuals with SCI to a reference population.
- To determine how sex, race/ethnicity, neurological deficit, and age influence plasma homocysteine levels in SCI.
Main Methods:
- Plasma homocysteine levels were measured in 845 subjects with SCI.
- Data were compared to a reference population and analyzed for differences based on demographic and clinical factors.
Main Results:
- Individuals with SCI had higher plasma homocysteine levels than the reference population.
- Higher levels were observed in men compared to women, and in older individuals (>50 years) compared to younger ones.
- Plasma homocysteine levels showed a positive correlation with age and serum creatinine concentration.
Conclusions:
- Elevated plasma homocysteine in older individuals with SCI increases their risk for vaso-occlusive events.
- Supplementation with folic acid, vitamin B12, and potentially vitamin B6 may help lower homocysteine levels.
Background:
Premature coronary vascular disease is a leading cause of morbidity and mortality in persons with chronic spinal cord injury (SCI). Evidence indicates that an elevated plasma homocysteine level is an independent risk factor for vascular disease.
Methods:
Plasma homocysteine levels were collected in 845 subjects with SCI and compared to those in a reference population. Differences in plasma homocysteine were determined for sex, race/ethnicity, neurological deficit, and age, as well as for serum creatinine concentration.
Results:
Plasma homocysteine was significantly higher in men than in women. Men were more likely to have moderately or severely elevated plasma homocysteine levels. Stratifying by male sex, greater percentages of whites and African Americans had severely elevated plasma homocysteine levels (>20 micromol/L) compared with Latinos (12% and 14% versus 8%; P > .01). For the total group with SCI, plasma homocysteine levels were not significantly different by race/ethnicity or neurological deficit subgroup. For the total group (P < .05) and within each sex (men, P < .05; women, P < .01), the older age group with SCI (>50 years) had significantly higher mean plasma homocysteine levels than the younger age group. Age was positively related to plasma homocysteine levels in men (P < .05) and women (P < .01). Plasma homocysteine levels were higher among men for any given age than among women (P < .0001) by an average of 3.19 +/- 0.51 micromol/L. Regardless of age or sex, persons with SCI tended to have higher levels of plasma homocysteine than able-bodied persons matched for age and sex.
Conclusion:
Because the risk of a vascular event increases with age, elevated levels of plasma homocysteine place older persons with SCI at further increased risk for a vaso-occlusive event. Of note, there was a stepwise increase in plasma homocysteine concentration for each quartile of higher serum creatinine concentration. Patients who have elevated levels of plasma homocysteine should receive a trial course of daily supplementation with oral folic acid and vitamin B12. If that is ineffective, they should receive vitamin B6 supplementation to lower their plasma homocysteine levels.
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