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[Homocysteine as a risk factor for ischemic heart disease]
Yukio Nakamura1, Hisashi Yoshizawa
1Department of Cardiology, Department of Clinical Research, National Kanazawa Hospital, Kanazawa 920-8650.
Insights
Elevated homocysteine levels are linked to more severe coronary artery narrowing in Japanese individuals. This suggests homocysteine contributes to chronic atherosclerosis, not acute coronary spasms, in ischemic heart disease development.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Epidemiology
Context:
- Hyperhomocysteinemia is a known risk factor for ischemic heart disease (IHD).
- The relationship between plasma total homocysteine (tHCY) and coronary atherosclerosis severity and morphology requires further investigation, particularly in diverse populations.
- Understanding these associations can inform preventative strategies for IHD.
Purpose:
- To investigate the association between plasma total homocysteine (tHCY) concentrations and the severity and morphology of coronary stenosis in Japanese patients.
- To determine if plasma tHCY levels are related to coronary spasm, a potential acute cause of IHD.
- To elucidate the specific mechanisms by which hyperhomocysteinemia contributes to IHD in this population.
Summary:
- A study of 238 Japanese patients revealed a positive correlation between plasma tHCY levels and coronary stenosis severity, with higher tHCY associated with more pronounced narrowing.
- Plasma tHCY levels were significantly higher in patients with diffuse coronary stenosis compared to those with no or focal stenosis.
- No significant difference in plasma tHCY levels was observed between patients with vasospastic angina and controls, indicating tHCY is not associated with coronary spasm.
Impact:
- The findings suggest that elevated plasma tHCY contributes to the development of ischemic heart disease in Japanese patients primarily through its role in chronic coronary atherosclerotic processes.
- This research highlights that hyperhomocysteinemia's impact on IHD in this population is linked to atherosclerosis, not acute coronary spasm.
- Further research is needed to clarify the role of tHCY in coronary thrombosis among Japanese patients.
Abstract:
Hyperhomocysteinemia is currently regarded as a risk factor for the development of ischemic heart disease (IHD). We examined the relation between plasma total homocysteine (tHCY) concentrations and the severity and morphology of coronary stenosis in 238 Japanese patients. Coronary stenosis score (CS) in the first quartile of plasma tHCY levels was 4.9 and the second, third and fourth quartiles were 6.5, 7.5, and 8.9, respectively and plasma tHCY levels were 8.5, 10.9, 13.5, and 22.4 mumol/l, respectively. CS was higher in the fourth quartile than in the first, suggesting that plasma tHCY levels are related to the coronary stenosis severity. Among 238 patients, 123 did not have any significant coronary stenosis (group 1), 98 had focal coronary stenosis (group 2) and 17 had diffuse coronary stenosis (group 3). Plasma tHCY level was higher in group 3 than in group 1 or 2, suggesting that plasma tHCY levels are related to the diffuse coronary stenosis. We also examined whether hyperhomocysteinemia is concerned in coronary spasm. Plasma tHCY levels did not differ between 43 patients with vasospastic angina and 43 patients without ischemic heart disease, suggesting that plasma tHCY levels are not concerned in coronary spasm. Therefore, in Japanese patients, plasma tHCY contributes to the development of IHD through the influence on chronic coronary atherosclerotic background, but not through the influence on coronary spasm, i.e., one of the acute ischemic stimuli. Whether or not tHCY influences coronary thrombosis should be clarified in Japanese patients.