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Hyperhomocysteinemia as the only risk factor in a young man presenting with ST-elevation myocardial infarction

Charalampos Varlamos1, Christos Pappas1, Estela Kiouri1

  • 1Second Department of Cardiology, "Attikon" University Hospital, Athens, Greece.

Journal of Cardiology Cases
|March 15, 2021
PubMed

Insights

Elevated homocysteine levels can be the sole risk factor for acute coronary syndrome in young adults. Early detection through homocysteine measurement is crucial, even without traditional cardiovascular risk factors.

Area of Science:

  • Cardiology
  • Genetics
  • Vascular Medicine

Background:

  • Hyperhomocysteinemia is a known risk factor for cardiovascular events.
  • Acute coronary syndromes (ACS) typically occur in older individuals with established risk factors.

Observation:

  • A 23-year-old male presented with acute coronary thrombosis.
  • The patient had no significant past medical history or conventional cardiovascular risk factors.

Findings:

  • This case suggests hyperhomocysteinemia can be the primary or sole risk factor for ACS in young individuals.
  • Optical coherence tomography (OCT) provided insights into the coronary occlusion.
  • Genetic testing for thrombophilia was considered due to the patient's young age and unusual presentation.

Implications:

  • Measuring homocysteine levels is vital in young patients experiencing ACS, particularly those lacking traditional risk factors.
  • Further research into the role of homocysteine in ACS and the efficacy of interventions like folic acid is warranted.
  • Consideration of genetic thrombophilia testing in unexplained ACS in young adults is recommended.

Keywords:
Coronary thrombusHomocysteineHyperhomocysteinemiaInherited metabolic disordersPremature myocardial infarctionPreventive medicine

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