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Hyperhomocysteinemia and transplant coronary artery disease
1Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
Insights
Hyperhomocysteinemia is common in heart transplant recipients and linked to transplant coronary artery disease (TCAD). Lowering homocysteine may be beneficial, but further research is needed.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Transplant coronary artery disease (TCAD) significantly impacts heart transplant recipient outcomes.
- Both immunologic and non-immunologic factors contribute to TCAD pathogenesis.
- Hyperhomocysteinemia is a known risk factor for atherosclerotic vascular disease.
Purpose of the Study:
- To determine the prevalence of hyperhomocysteinemia in heart transplant recipients.
- To review the literature on the association between hyperhomocysteinemia and TCAD.
- To explore potential therapeutic interventions for hyperhomocysteinemia in this population.
Main Methods:
- A comprehensive literature search was conducted using MEDLINE.
- Keywords included "hyperhomocysteinemia," "transplant coronary artery disease," and "heart transplant."
- The review focused on studies investigating the prevalence and clinical significance of hyperhomocysteinemia.
Main Results:
- Hyperhomocysteinemia affects 51% to 76% of heart transplant recipients.
- Worsening renal function and impaired vitamin metabolism are key contributors.
- Higher homocysteine levels correlate with increased prevalence and severity of TCAD.
- Vitamin supplementation effectively reduces homocysteine levels and is safe.
Conclusions:
- Hyperhomocysteinemia is highly prevalent in heart transplant recipients.
- A strong association exists between hyperhomocysteinemia and TCAD.
- Further large-scale, placebo-controlled trials are necessary to confirm the clinical benefits of homocysteine-lowering therapies on TCAD progression.
Background:
Transplant coronary artery disease (TCAD) is a major cause of morbidity and mortality among heart transplant recipients. A variety of immunologic and nonimmunologic mechanisms are involved in the pathogenesis of the disease. Hyperhomocysteinemia has been recognized as an important risk factor for atherosclerotic vascular disease. The purpose of this article is to evaluate the prevalence of hyperhomocysteinemia in heart transplant recipients but more specifically to assess the published literature regarding the association between hyperhomocysteinemia and TCAD.
Methods:
A MEDLINE search using the key words hyperhomocysteinemia, transplant coronary artery disease, and heart transplant was performed.
Results:
Hyperhomocysteinemia has been commonly found among heart transplant recipients (average prevalence 51% to 76%). Worsening renal function and impaired vitamin metabolism seem to be the major causes of hyperhomocysteinemia in this particular population. TCAD has been found to be more prevalent and severe among patients with higher serum homocysteine levels. Vitamin supplementation is safe and effective in reducing serum homocysteine among heart transplant recipients.
Conclusion:
A large, long-term, double-blind, placebo-controlled prospective trial aimed at assessing the clinical significance of homocysteine-lowering therapy on the natural history of TCAD seems warranted.