The current status of homocysteine as a risk factor for cardiovascular disease: a mini review
Steven G Chrysant1, George S Chrysant2
1a Department of Cardiology , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA.
Insights
Hyperhomocysteinemia is a controversial risk factor for cardiovascular disease and stroke. Current evidence is conflicting, questioning the need for routine homocysteine screening in patients.
Area of Science:
- Cardiovascular Science
- Metabolic Disease Research
- Neurology
Background:
- Hyperhomocysteinemia has been historically linked to increased risk of atherosclerosis, cardiovascular disease (CVD), and stroke.
- Early studies suggested a correlation between high homocysteine levels and these conditions, with potential benefits from folic acid and B vitamin treatment.
- However, recent randomized trials have yielded conflicting results, possibly due to widespread folic acid fortification.
Purpose of the Study:
- To review the current controversy surrounding homocysteine as a risk factor for CVD and stroke.
- To evaluate the significance of homocysteine levels and their management in clinical practice.
- To determine if routine screening for homocysteine is warranted.
Main Methods:
- A focused Medline literature search was conducted for English language papers published between 2010 and 2017.
- Keywords included: homocysteine, risk factor, atherosclerosis, cardiovascular disease, stroke, and treatment.
- 38 relevant papers were selected for review and expert commentary.
Main Results:
- The review highlights a significant controversy regarding the role of homocysteine in the development of CVD and stroke.
- Conflicting data exists on whether high homocysteine levels or their reduction through treatment impacts the incidence of these conditions.
- The impact of folic acid fortification on study outcomes is a key consideration.
Conclusions:
- There is ongoing debate about the clinical significance of homocysteine as a risk factor for cardiovascular disease and stroke.
- The utility of routine homocysteine screening in patients remains uncertain due to conflicting evidence.
- Further research and expert commentary are needed to clarify homocysteine's role and guide clinical recommendations.
Introduction:
Hyperhomocysteinemia has been considered as a risk factor for systemic atherosclerosis, cardiovascular disease (CVD) and stroke and many epidemiologic and case-controlled studies have demonstrated its association with these complications. In addition, treatment of hyperhomocysteinemia with folic acid ± B vitamins prevents the development of atherosclerosis, CVD and strokes. However, subsequent prospective, randomized, placebo-controlled trials have not shown an association of high homocysteine levels or their lowering with treatment with the incidence of atherosclerosis, CVD or strokes, due possibly, to the fortification of flower with folic acid. Therefore, at present, there is a controversy regarding the significance of homocysteine as a risk factor for CVD and stroke and whether patients should be routinely screened for homocysteine. Areas covered: For these reasons, a focused Medline search of the English language literature was conducted between 2010 and 2017 using the terms, homocysteine, risk factor, atherosclerosis, cardiovascular disease, stroke, treatment, and 38 papers with pertinent information were selected. Expert commentary: The review of data disclosed that there is a great controversy regarding the significance of homocysteine as a risk factor for CVD and stroke. The data from these papers together with collateral literature will be discussed in this mini review.
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