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Homocysteine-lowering treatment in coronary heart disease
M Cesari1, G P Rossi, A C Pessina
1Department of Clinical & Experimental Medicine, Clinica Medica 4, University of Padova, Italy. mcesari@hotmail.com
Insights
High homocysteine (HHcy) is a cardiovascular disease risk factor, especially in patients with existing conditions. Vitamin treatment can lower homocysteine levels, but its effectiveness in preventing events requires further study.
Area of Science:
- Biochemistry
- Cardiology
- Nutritional Science
Background:
- Homocysteine (Hcy) is a metabolite of methionine.
- Elevated homocysteine (Hyperhomocysteinemia, HHcy) is an independent risk factor for cardiovascular (CV) disease, particularly in high-risk individuals.
- HHcy may contribute to coronary heart disease (CHD) events, especially when interacting with other CV risk factors.
Purpose of the Study:
- To review the role of HHcy in the development of CHD.
- To discuss the benefits of vitamin supplementation for lowering total homocysteine (tHcy) plasma levels.
- To clarify which patient groups warrant HHcy screening and homocysteine-lowering treatment.
Main Methods:
- Review of existing literature, including case-control, cross-sectional, and prospective studies.
- Analysis of evidence regarding the association between HHcy and CV disease.
- Evaluation of studies on the efficacy of vitamin supplementation in reducing tHcy and preventing CV events.
Main Results:
- Consistent association between HHcy and CV disease in observational studies.
- Conflicting results from prospective studies on the predictive value of HHcy.
- Ongoing debate regarding the clinical benefit of homocysteine-lowering therapy in preventing CV events.
Conclusions:
- HHcy is a correctable CV risk factor through vitamin supplementation.
- The precise role of HHcy and the effectiveness of its reduction in preventing CV events remain subjects of ongoing research and clinical debate.
- Further research is needed to guide screening and treatment strategies for HHcy.
Abstract:
Homocysteine (Hcy) is a sulphur-containing amino acid product of methionine's metabolism. Hyperhomocysteinemia (HHcy) is considered an independent risk factor for cardiovascular (CV) disease, at least in high-risk patients. In fact, evidence indicates that although mild HHcy may be regarded as a minor risk factor for CHD in low-risk patients, it can play a role in triggering new events in patients with known CHD, also by interacting with the "classical" CV risk factors. This is of much interest because HHcy represents a correctable risk factor, inasmuch vitamin supplementation as has been shown to effectively lower total homocysteine plasma levels (tHcy). While case-control and cross-sectional studies have consistently demonstrated an association of HHcy with CV disease, prospective studies have given conflicting results. Moreover, the effect of the homocysteine-lowering treatment in preventing CV events is still under debate. Thus, it remains unclear which patients should be screened for HHcy and which ones should be treated to lower tHcy. In this paper we shall report and discuss knowledge on the potential role of HHcy in the development of CHD and on the benefits due to tHcy-lowering treatment with vitamins.
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