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Hyperhomocysteinemia and related factors in 600 hospitalized elderly subjects
P Ventura1, R Panini, C Verlato
1Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Insights
Hyperhomocysteinemia (HHcy) is common in elderly patients, often linked to vascular and cognitive issues. Key predictors include age, folate levels, and diuretic use, suggesting it
Area of Science:
- Gerontology
- Metabolic Disorders
- Clinical Medicine
Background:
- Hyperhomocysteinemia (HHcy) is a metabolic disorder prevalent in the elderly.
- Emerging evidence links HHcy to geriatric illnesses, particularly atherosclerotic vascular diseases and cognitive impairment.
- Understanding HHcy's prevalence and predictors in hospitalized elderly is crucial for managing age-related conditions.
Purpose of the Study:
- To determine the prevalence of HHcy in hospitalized elderly subjects.
- To investigate the association between HHcy and vascular/cognitive disorders.
- To identify independent predictors of HHcy in this population.
Main Methods:
- A cohort of 600 elderly inpatients was studied over 3 years.
- Measurements included fasting and post-methionine load homocysteine, BMI, MUAMA, lipids, proteins, albumin, lymphocytes, creatinine, and vitamin levels.
- Data on comorbidities and medication use were also collected.
Main Results:
- The prevalence of HHcy (fasting tHcy ≥ 15 µmol/L or post-methionine load tHcy ≥ 35 µmol/L) was 61%, higher in men (67%) than women (56%).
- HHcy was frequently associated with diabetes, renal failure, malnutrition, heart failure, malignancies, and use of diuretics and anticonvulsants.
- Plasma homocysteine levels increased with the number of concurrent diseases.
Conclusions:
- HHcy is a common finding in elderly hospitalized patients, often associated with vascular and cognitive disorders.
- HHcy appears to be a secondary phenomenon in most cases within this demographic.
- Age, serum folate, plasma albumin, creatinine clearance, and diuretic use are major predictors of elevated plasma homocysteine levels, explaining significant variability.
Abstract:
Hyperhomocysteinemia (HHcy) is a metabolic disorder frequently occurring in the elderly population. Recently several reports have suggested abnormalities in homocysteine (tHcy) metabolism implicating HHcy as a metabolic link in the multifactorial processes characterizing many geriatric illnesses-with special emphasis on atherosclerotic vascular diseases and cognitive impairment. The present study was undertaken in a large sample of elderly hospitalized subjects to determine (1) the prevalence of HHcy, (2) the association of HHcy with vascular and cognitive disorders, and (3) the factors independently predicting Hhcy. Six hundred elderly subjects (264 men and 336 women; mean age, 79 +/- 9 years) were randomly chosen from those admitted as inpatients over a period of 3 years. In all patients, body mass index (BMI), mid-upper arm muscle area (MUAMA), plasma cholesterol, triglycerides, total proteins, albumin, lymphocyte count, creatinine, homocysteine (fasting and 4 hours after methionine oral load), serum vitamin B(6), vitamin B(12), and folate concentrations were measured. The presence of disease or use of medications known to affect homocysteine plasma levels were also recorded. The mean fasting tHcy level was 16.8 +/- 12 micromol/L in the whole sample, 18.18 +/- 13.25 micromol/L in men, and 15.86 +/- 12.14 micromol/L in women (P =.005 men v women). The mean Hcy level 4 hours after methionine load was 37.95 +/- 20.9 in the whole sample. Prevalence of hyperhomocysteinemia (fasting Hcy > or = 15 micromol/L or 4 hours after methionine load > or = 35 micromol/L) was 61% (365/600) (67% in men and 56% in women, P <.05). HHcy was rarely (8%) an isolated disorder; in addition to diabetes (20%), renal failure (48.2%), and malnutrition (20.2%), it was often associated with heart failure (30%), malignancies (20.5%), and the use of diuretics (56%) and anticonvulsant drugs (13%). Plasma homocysteine progressively increases across subjects from those with no diabetes, malnutrition, renal failure, obesity, inflammatory bowel disease, heart failure to those with 1, 2, or more concurrent diseases. Multiple stepwise regression analysis showed that 72% of plasma total fasting tHcy variability was explained by age, serum folate, plasma albumin, use of diuretics, and renal function (measured as plasma creatinine clearance). In conclusion, the present study documents that hyperhomocysteinemia, in elderly hospitalized patients is (1) a common finding, (2) frequently associated with vascular and cognitive disorders, and (3) probably a secondary phenomenon in most cases. The major predictor of high plasma homocysteine levels were age, serum folate, plasma albumin, plasma creatinine clearance, and use of diuretic drugs. These variables explain a large proportion of plasma Hcy variability.