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Hyperhomocysteinemia and coronary artery disease in Pakistan

M Perwaiz Iqbal1

  • 1Department of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi.

JPMA. the Journal of the Pakistan Medical Association
|July 11, 2006
PubMed

Insights

Coronary artery disease (CAD) risk in Pakistani men is high, especially in younger individuals. Mild hyperhomocysteinemia is common but not directly linked to CAD, with nutrient deficiencies being a likely cause.

Area of Science:

  • Cardiovascular Medicine
  • Nutritional Epidemiology
  • Population Health

Background:

  • Coronary artery disease (CAD) poses a significant health burden, particularly in Pakistani men at younger ages.
  • The lower-middle socioeconomic strata are disproportionately affected by CAD.
  • Mild hyperhomocysteinemia is prevalent in the Pakistani population, affecting both patients with acute myocardial infarction (AMI) and healthy individuals.

Purpose of the Study:

  • To investigate the association between hyperhomocysteinemia and CAD in the Pakistani population.
  • To explore the role of methylenetetrahydrofolate reductase (MTHFR) 677C>T mutation in CAD risk.
  • To identify the underlying causes of hyperhomocysteinemia in this demographic.

Main Methods:

  • Observational study design.
  • Measurement of plasma homocysteine levels.
  • Assessment of MTHFR 677C>T mutation status.
  • Evaluation of folate, vitamin B6, and vitamin B12 levels.

Main Results:

  • No significant association was found between hyperhomocysteinemia and CAD in Pakistani individuals.
  • The MTHFR 677C>T mutation did not show evidence of association with CAD.
  • A high prevalence of folate and vitamin B6 deficiency was identified as a major contributor to hyperhomocysteinemia.

Conclusions:

  • Mild hyperhomocysteinemia is common in Pakistan but not a direct risk factor for CAD in this population.
  • Micronutrient deficiencies, particularly folate and vitamin B6, are key drivers of hyperhomocysteinemia.
  • Combined deficiencies and mild hyperhomocysteinemia may synergistically interact with classical risk factors to elevate CAD risk.

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