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Published on: October 12, 2017
Homocysteine and large arteries
Coen van Guldener1, Coen D A Stehouwer
1Department of Internal Medicine, Amphia Hospital, Breda , The Netherlands.
Insights
High homocysteine levels are linked to cardiovascular risks, but lowering them hasn't consistently reduced major events. Further research is needed to clarify the relationship between homocysteine and arterial stiffness.
Area of Science:
- Cardiovascular Science
- Metabolic Disorders
- Biochemistry
Background:
- Elevated plasma homocysteine is associated with atherothrombotic disease in both rare metabolic disorders and the general population.
- Hyperhomocysteinemia presents a significant, albeit modest, cardiovascular risk that may vary across different populations.
- Proposed mechanisms include endothelial dysfunction, increased oxidative stress, impaired methylation, and altered protein structure.
Purpose of the Study:
- To investigate the association between plasma homocysteine concentrations and atherothrombotic disease.
- To evaluate the impact of homocysteine-lowering treatments on cardiovascular events.
- To examine the heterogeneous results regarding plasma homocysteine and arterial stiffness.
Main Methods:
- Observational studies on individuals with inborn errors of homocysteine metabolism.
- Population-based studies assessing cardiovascular risk.
- Clinical trials of homocysteine-lowering interventions.
- Studies analyzing plasma homocysteine levels and arterial stiffness parameters.
Main Results:
- A consistent association between high homocysteine and atherothrombotic disease is observed.
- Homocysteine-lowering treatments have not yet demonstrated a significant reduction in major cardiovascular events.
- Studies on arterial stiffness parameters have yielded inconsistent findings.
Conclusions:
- While high homocysteine is a risk factor for cardiovascular disease, its clinical impact and the efficacy of lowering treatments require further clarification.
- The relationship between homocysteine and arterial stiffness remains uncertain due to heterogeneous study results.
- Further research is warranted to fully understand the role of homocysteine in cardiovascular pathology and to optimize therapeutic strategies.
Abstract:
High plasma concentrations of the amino acid homocysteine have been associated with atherothrombotic disease, first in individuals with inborn errors of homocysteine metabolism, who have very high plasma homocysteine concentrations, and later also in the general population. In general, the cardiovascular risk associated with hyperhomocysteinemia is significant, but modest and probably differs between populations. High homocysteine concentrations are thought to impair endothelial function, increase oxidative stress, impair methylation reactions, and alter protein structure. Although some studies have shown improvement of vascular surrogate end points, homocysteine-lowering treatment has not yet been associated with a significant reduction of cardiovascular events. Studies that have examined the relationship between plasma homocysteine and arterial stiffness parameters have shown heterogenous results.
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