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Hyperhomocysteinemia in patients with symptomatic chronic heart failure: prevalence and prognostic importance--pilot

Marek Naruszewicz1, Ewa A Jankowska, Robert Zymlinski

  • 1Department of Clinical Biochemistry and Laboratory Diagnostics, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland. mnarusze@sci.pam.szczecin.pl

Atherosclerosis
|September 15, 2006
PubMed

Insights

Hyperhomocysteinemia (HHcy) is prevalent in chronic heart failure (CHF) patients, linked to disease severity and poor prognosis. Addressing HHcy may improve outcomes in CHF.

Area of Science:

  • Cardiology
  • Metabolic Medicine
  • Clinical Research

Background:

  • Chronic heart failure (CHF) patients may be susceptible to adverse effects of hyperhomocysteinemia (HHcy).
  • Prevalence, clinical determinants, and prognostic implications of HHcy in CHF require further investigation.

Purpose of the Study:

  • To assess the prevalence of HHcy (plasma homocysteine [Hcy] ≥ 14 µmol/L) in an unselected CHF cohort.
  • To identify clinical and metabolic determinants of HHcy in CHF.
  • To evaluate the prognostic impact of HHcy on mortality in CHF patients.

Main Methods:

  • Study included 108 consecutive CHF patients (mean age 66±11 years).
  • Plasma Hcy levels were measured, with HHcy defined as ≥ 14 µmol/L.
  • Multivariable regression models were used to identify predictors of HHcy and its association with mortality.

Main Results:

  • 35% of CHF patients (38 out of 108) had HHcy (mean Hcy 12.5±5.5 µmol/L).
  • Advanced NYHA class, elevated NT-proBNP, reduced peak oxygen consumption, lower glomerular filtration rate, and hyperuricemia predicted HHcy.
  • HHcy was independently associated with increased 3-year mortality (HR=3.26), with survival rates of 37% vs. 73% for normal Hcy levels (P<0.0001).

Conclusions:

  • HHcy is common in CHF patients.
  • HHcy is associated with disease severity and generalized metabolic imbalance, including hyperuricemia.
  • HHcy independently predicts a poor long-term prognosis in CHF.
Abstract

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