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Homocysteine - from disease biomarker to disease prevention

A D Smith1, H Refsum1,2

  • 1From the, University Department of Pharmacology, Oxford, UK.

Journal of Internal Medicine
|March 4, 2021
PubMed

Insights

Raised plasma total homocysteine is linked to over 100 diseases. Lowering homocysteine with B vitamins may prevent conditions like stroke and cognitive impairment, suggesting intervention for levels above 10 μmol/L.

Area of Science:

  • Biochemistry
  • Clinical Medicine
  • Preventive Medicine

Background:

  • Elevated plasma total homocysteine is associated with over 100 diseases, notably cardiovascular and central nervous system conditions.
  • Few biomarkers exhibit such a wide range of disease associations.
  • The clinical significance is amplified if homocysteine reduction can prevent disease.

Purpose of the Study:

  • To review the literature on diseases associated with elevated plasma total homocysteine.
  • To assess the potential of lowering homocysteine through B vitamin treatment for disease prevention.
  • To establish safe and intervention thresholds for plasma total homocysteine levels.

Main Methods:

  • Comprehensive literature review of studies identifying diseases linked to raised plasma total homocysteine.
  • Analysis of the impact of B vitamin treatment on lowering homocysteine and preventing associated diseases.
  • Evaluation of established homocysteine concentration thresholds for clinical relevance.

Main Results:

  • Over 100 diseases and conditions are associated with elevated plasma total homocysteine.
  • Five conditions, including neural tube defects, stroke, and cognitive impairment, can be partially prevented by lowering homocysteine.
  • Plasma total homocysteine levels of 10 μmol/L or below appear safe, while levels of 11 μmol/L or above may warrant intervention.

Conclusions:

  • Plasma total homocysteine is a significant biomarker with broad disease associations.
  • Lowering homocysteine via B vitamin supplementation offers a preventive strategy for several key health conditions.
  • A plasma total homocysteine level of 11 μmol/L or higher in adults suggests a need for potential intervention.

Keywords:
B vitaminscardiovascular diseasecognitive impairmentdementiastroke

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