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Homocysteine or renal impairment: which is the real cardiovascular risk factor?

Kathleen Potter1, Graeme J Hankey, Daniel J Green

  • 1Department of Cardiology, Level 4, A Block, Royal Perth Hospital, Perth WA6847, Australia. pottek04@cyllene.uwa.edu.au

Arteriosclerosis, Thrombosis, and Vascular Biology
|March 22, 2008
PubMed

Insights

Adjusting for kidney function removes the link between total plasma homocysteine (tHcy) and vascular risk markers like CIMT and FMD. This suggests high tHcy indicates kidney problems, not independent heart disease risk.

Area of Science:

  • Cardiovascular Research
  • Nephrology
  • Biochemistry

Background:

  • Elevated total plasma homocysteine (tHcy) is linked to cardiovascular disease.
  • The role of renal function in this association is not fully understood.

Purpose of the Study:

  • To investigate if adjusting for renal function markers eliminates the relationship between tHcy and vascular risk.
  • To assess tHcy as an independent cardiovascular risk factor versus a marker of renal impairment.

Main Methods:

  • Cross-sectional analysis of 173 stroke patients from a B-vitamin/placebo trial.
  • Regression models assessed relationships between tHcy, renal markers (cystatin C, eGFR, creatinine), carotid intima-medial thickness (CIMT), and flow-mediated dilation (FMD).

Main Results:

  • The strong tHcy-cystatin C relationship persisted despite B-vitamin treatment.
  • tHcy was no longer significant for predicting CIMT or FMD after adjusting for renal function.
  • Cystatin C independently predicted FMD, but tHcy did not.

Conclusions:

  • Adjusting for renal function markers abolishes the association between tHcy and vascular measures (CIMT, FMD).
  • These findings support the hypothesis that elevated tHcy is primarily a marker of impaired renal function, not an independent cardiovascular risk factor.
Abstract

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