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Serum Homocysteine, Folate, and Vitamin B12 Levels in Patients with Systemic Lupus Erythematosus: A Meta-Analysis and
Tsung-Yu Tsai1, Tsai-Hsien Lee2, Hsiao-Han Wang1,3
1Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Insights
Patients with systemic lupus erythematosus (SLE) have higher homocysteine and lower vitamin B12 levels. Monitoring these may help manage cardiovascular risk in SLE patients.
Area of Science:
- Endocrinology
- Rheumatology
- Clinical Biochemistry
Background:
- Systemic lupus erythematosus (SLE) is associated with increased cardiovascular risk.
- Hyperhomocysteinemia is a potential contributing factor to this elevated risk.
- Understanding homocysteine metabolism in SLE is crucial for risk stratification.
Purpose of the Study:
- To compare serum homocysteine, folate, and vitamin B12 levels in individuals with and without SLE.
- To investigate the role of these biomarkers in the pathophysiology of SLE.
- To provide evidence for potential therapeutic targets in managing SLE complications.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, and Cochrane Library up to March 31, 2019.
- Included studies compared serum homocysteine, folate, or vitamin B12 levels between SLE patients and controls.
- Meta-analysis and meta-regression were performed on data from 50 selected studies involving 4396 participants.
Main Results:
- Patients with SLE exhibited significantly higher serum homocysteine levels (SMD, 1.134) and lower vitamin B12 levels (SMD, -0.359) compared to controls.
- No significant difference in folate levels was observed between SLE patients and the control group (SMD, -0.276).
- Meta-regression revealed an inverse correlation between homocysteine levels and complement C3 and C4 levels in SLE patients.
Conclusions:
- Individuals with SLE demonstrate elevated serum homocysteine and reduced vitamin B12 levels.
- These findings underscore the importance of monitoring homocysteine and vitamin B12 in SLE management.
- Timely interventions targeting these metabolic parameters may help mitigate cardiovascular risks in SLE patients.
Background:
Patients with systemic lupus erythematosus (SLE) have elevated cardiovascular risk. Hyperhomocysteinemia may be one of the contributing factors to this phenomenon. This study therefore aimed to compare the serum homocysteine levels and the levels of folate and vitamin B12, cofactors for homocysteine metabolism, between individuals with and without SLE.
Methods:
A literature search was performed in PubMed, Embase, and the Cochrane library (from inception to March 31, 2019). Studies comparing serum homocysteine, folate or vitamin B12 levels between individuals with and without SLE were selected. Of the 1040 screened studies, 50 studies met the inclusion criteria.
Results:
A total of 50 studies involving 4396 patients with SLE were included. Patients with SLE had a significantly higher serum level of homocysteine (standardized mean difference [SMD], 1.134; 95% CI, 0.795-1.474) and lower level of vitamin B12 (SMD, -0.359; 95% CI, -0.638 to -0.080) than controls. The folate level didn't differ markedly between SLE patients and the control group (SMD, -0.276; 95% CI, -0.674-0.123). Subgroup analysis showed consistent results in adult SLE patients. A random effects meta-regression analysis revealed a significantly inverse correlation between the SMD of homocysteine levels and C3 levels (coefficient, -0.0356, 95% CI, -0.054 to -0.0171; P < .001) and C4 levels (coefficient, -0.0876, 95% CI, -0.1407 to -0.0345; P = .0012).
Conclusions:
Serum homocysteine levels were higher and vitamin B12 levels were lower among individuals with SLE than those without SLE. Physicians are encouraged to monitor these parameters and offer timely interventions for patients with SLE.
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