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Hyperhomocysteinemia in patients with heart failure referred for cardiac transplantation: preliminary observations
Richard S Schofield1, Timothy R Wessel, Tracy C Walker
1Division of Cardiovascular Medicine and Shands Transplant Center, University of Florida College of Medicine, Gainesville, Florida, USA. schofrs@medicine.ufl.edu
Insights
Hyperhomocysteinemia, a risk factor for cardiovascular disease, is highly prevalent in severe heart failure patients. Elevated homocysteine levels correlate with kidney function and diabetes, suggesting a link to heart failure-related renal insufficiency.
Area of Science:
- Cardiology
- Clinical Biochemistry
Background:
- Hyperhomocysteinemia is an emerging cardiovascular disease risk factor.
- Limited data exist on its prevalence in heart failure patients.
Purpose of the Study:
- To determine the prevalence of hyperhomocysteinemia in severe heart failure.
- To correlate homocysteine levels with factors influencing its metabolism.
Main Methods:
- Measured serum homocysteine in 89 severe heart failure patients undergoing cardiac transplant evaluation.
- Compared levels between ischemic (ICM) and non-ischemic (NICM) cardiomyopathy.
- Correlated homocysteine with demographic, hemodynamic, and functional parameters.
Main Results:
- Mean homocysteine was elevated (14.3 micromol/l) and similar in ICM and NICM.
- 89% of patients had hyperhomocysteinemia, common in both NICM (94%) and ICM (85%).
- Homocysteine correlated with creatinine, diabetes, and peripheral vascular disease; folic acid use was low (6%).
Conclusions:
- Hyperhomocysteinemia is common in severe heart failure, irrespective of etiology.
- Elevated homocysteine is likely due to heart failure-related renal insufficiency.
Background:
Hyperhomocysteinemia is becoming recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with heart failure.
Hypothesis:
The purpose of this study was to examine the prevalence of hyperhomocysteinemia in patients with severe heart failure and to correlate serum homocysteine levels with factors that may affect homocysteine metabolism.
Methods:
Serum homocysteine levels were measured at the time of cardiac transplant evaluation in 89 consecutive patients with severe heart failure. Homocysteine levels for patients with ischemic cardiomyopathy (ICM) were compared with levels obtained in patients with nonischemic cardiomyopathy (NICM), and homocysteine levels were correlated with demographic and hemodynamic parameters as well as functional status.
Results:
The mean plasma homocysteine level was increased (14.3 +/- 5.3 micromol/l, normal <9.0 micromol/l) and was equivalent between patients with ICM versus NICM (14.7 +/- 5.8 micromol/l vs. 13.8 +/- 4.5 micromol/l, p = 0.44). Elevated homocysteine levels were seen in a large proportion (89%) of patients and were equally common to patients with NICM (94%) and ICM (85%). Serum homocysteine levels correlated with serum creatinine (r = 0.51, p < 0.001), with a history of diabetes (p = 0.028), and with a history of peripheral vascular disease (p = 0.045). Only 6% of patients were receiving folic acid therapy at the time of transplant referral.
Conclusion:
Hyperhomocysteinemia is common in patients with severe heart failure, and plasma homocysteine levels are uniformly elevated regardless of the etiology of heart failure. Elevated plasma homocysteine levels are likely a consequence of heart failure-related renal insufficiency.
