[Hyperhomocysteinemia in pediatric age and nutritional aspects of folates: an early cardiovascular risk factor]

Area of Science:

• Cardiovascular Science
• Biochemistry
• Medical Research

Context:

• Growing evidence links elevated plasma homocysteine to increased risk of atherosclerosis and cardiovascular ischemic events.
• The precise mechanisms of homocysteine's pro-atherogenic effects and the impact of its reduction on cardiovascular risk remain under investigation.
• Experimental studies suggest multiple mechanisms contribute to homocysteine's pro-atherogenic effects, including endothelial dysfunction.

Purpose:

• To review the current understanding of homocysteine's role in cardiovascular disease.
• To explore the mechanisms by which homocysteine may exert its pro-atherogenic effects.
• To assess the potential impact of homocysteine reduction on cardiovascular risk.

Summary:

• Elevated homocysteine is associated with atherosclerosis and ischemic events, with endothelial dysfunction being a key implicated mechanism.
• Exercise training can lower homocysteine and improve endothelial function, but clinical outcome benefits are not yet proven.
• Larger studies are required to establish whether reducing homocysteine levels with folate and B vitamin supplementation decreases ischemic event incidence, particularly in patients with existing coronary artery disease or ischemic encephalopathy.

Impact:

• Highlights the need for further clinical trials to validate homocysteine-lowering therapies for cardiovascular risk reduction.
• Emphasizes the importance of understanding the mechanistic links between homocysteine, endothelial function, and atherogenesis.
• Provides a concise overview for researchers and clinicians regarding the current state of knowledge on homocysteine and cardiovascular health.