Measuring subclinical atherosclerosis: is homocysteine relevant?

Area of Science:

• Cardiovascular Medicine
• Biochemistry
• Medical Diagnostics

Background:

• Total serum homocysteine (tHcy) is associated with clinically apparent atherosclerotic disease.
• Current guidelines do not incorporate tHcy for subclinical disease diagnosis in high-risk asymptomatic individuals.

Purpose of the Study:

• To systematically review studies on the relationship between tHcy and subclinical atherosclerosis markers (C-IMT, CAC, ABI) in asymptomatic individuals.
• To assess the potential of tHcy for inclusion in atherosclerotic disease management guidelines.

Main Methods:

• Systematic review of 19 articles from online databases (e.g., PUBMED, MEDLINE).
• Included studies focused on asymptomatic populations and excluded symptomatic individuals or those with prior cardiovascular events.
• Analyzed associations between tHcy levels and C-IMT, CAC, and ABI.

Main Results:

• Most studies showed a significant association between elevated tHcy and subclinical atherosclerosis markers.
• Higher mean tHcy levels were observed in men compared to women.
• Studies lowering tHcy did not improve atherosclerosis markers, suggesting tHcy is more a marker than a risk factor.

Conclusions:

• A significant association exists between tHcy and subclinical atherosclerosis, indicating its potential as a low-cost risk stratification marker.
• Further research is needed to elucidate the exact role of tHcy in atherosclerosis.
• Plasma tHcy levels may be incorporated into future risk reduction protocols for identifying high-risk individuals.