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Homocysteine and vascular disease
C S Berwanger1, J Y Jeremy, G Stansby
1Academic Surgical Unit, St Mary's Hospital Medical School, London, UK.
The British Journal of Surgery
|June 1, 1995
Summary
High homocysteine (HC) levels are a risk factor for premature atherosclerosis, especially in young individuals. Lowering HC with vitamins B6, B12, folate, or betaine is a potential treatment, though its effectiveness is still under investigation.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Biochemistry
Background:
- Elevated blood homocysteine (HC) is increasingly recognized as a risk factor for premature atherosclerosis.
- The genetic prevalence of conditions leading to high HC suggests it may be more common than previously estimated.
- High HC should be suspected in young patients lacking other atherosclerosis risk factors.
Purpose of the Study:
- To review the evidence linking elevated homocysteine levels to premature vascular disease.
- To discuss diagnostic methods for identifying hyperhomocysteinemia.
- To outline current treatment strategies aimed at reducing homocysteine levels.
Main Methods:
- Review of existing scientific literature on homocysteine and atherosclerosis.
- Analysis of studies demonstrating elevated plasma HC in patients with premature vascular diseases.
- Examination of proposed mechanisms of HC-induced vascular damage.
Main Results:
- Significantly increased homocysteine levels were observed in patients with premature coronary, peripheral, and cerebrovascular diseases.
- Endothelial injury is considered a likely mechanism through which HC contributes to vascular damage.
- Diagnostic approaches include measuring basal or post-methionine-load plasma HC levels.
Conclusions:
- Hyperhomocysteinemia is a significant risk factor for premature atherosclerosis, particularly in younger individuals.
- Treatment involves lowering blood HC levels using vitamin B6, vitamin B12, folate, or betaine.
- The clinical efficacy of homocysteine-lowering therapy in preventing vascular complications requires further research.