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Hyperhomocysteinaemia: a significant risk factor for cardiovascular disease in renal transplant recipients
Z A Massy1, B Chadefaux-Vekemans, A Chevalier
1Transplantation Unit, Hôpital Necker, Paris, France.
Insights
Elevated homocysteine levels are common in kidney transplant recipients (RTR). High homocysteine is a significant risk factor for cardiovascular disease (CVD) in these patients, alongside triglycerides.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Cardiovascular disease (CVD) is a major cause of mortality in renal transplant recipients (RTR).
- Moderate hyperhomocysteinaemia is an independent risk factor for CVD, but data in RTR are limited.
- Understanding homocysteine levels in RTR is crucial for assessing cardiovascular risk.
Purpose of the Study:
- To investigate serum homocysteine levels in RTR.
- To determine the association between homocysteine levels and cardiovascular events in RTR.
- To identify risk factors for CVD in RTR.
Main Methods:
- Serum homocysteine levels were measured in 42 RTR using a radioenzymatic method.
- Patients were categorized into CVD (+) and CVD (-) groups based on ischaemic events.
- Logistic regression and discriminant analysis were used to identify risk factors.
Main Results:
- RTR exhibited significantly higher mean homocysteine levels compared to controls (P < 0.001).
- Higher homocysteine levels were observed in male RTR with CVD events (P < 0.06).
- Elevated homocysteine (>14 microM) was more frequent in RTR with CVD events (P = 0.04).
- Serum triglycerides and homocysteine were identified as risk factors for CVD in RTR.
Conclusions:
- Significant hyperhomocysteinaemia is prevalent in renal transplant recipients.
- Elevated homocysteine is a potential risk factor for cardiovascular disease in RTR.
- Monitoring homocysteine and triglycerides may aid in managing CVD risk in RTR.
Abstract:
Moderate hyperhomocysteinaemia has been shown to constitute an independent risk factor for cardiovascular disease (CVD), a frequent cause of morbidity and mortality in renal transplant recipients (RTR). In these patients few data regarding both total homocysteine levels and their influence on cardiovascular risk have been reported. We therefore studied serum homocysteine levels in deep-frozen sera from 42 kidney transplant recipients with a follow-up of 11 +/- 4.5 years (mean +/- SD) after transplantation. Eighteen patients had one or more ischaemic events (CVD (+)) and 24 patients had none (CVD (-)). Serum samples had been drawn 1-6 months prior to the first vascular event in CVD (+) patients and serum storage time was comparable in both CVD (-) and CVD (+) patients. Serum homocysteine levels were measured using a radioenzymatic method. Mean homocysteine level was significantly higher in 42 RTR males and females (15.5 +/- 6.3, 13.5 +/- 5.5 microM respectively) compared with 35 control subjects matched for age and sex (8.7 +/- 1.9, 7.5 +/- 1.9 microM, P < 0.001). The difference in serum homocysteine levels between CVD (+) and CVD (-) RTR nearly reached statistical significance in male patients (18.6 +/- 7.8 versus 13.1 +/- 3.4 microM, P < 0.06) but not in female patients (P = NS). In the CVD (+) group 11/18 patients had homocysteine levels > 14 microM (the upper limit in healthy controls) versus 7/24 in the CVD (-) group (P = 0.04). In these patients we simultaneously measured in the same serum samples, serum triglycerides, and total and HDL cholesterol, and calculated LDL cholesterol. By stepwise discriminant analysis and by logistic regression analysis in this relatively small patient population, only serum triglycerides and homocysteine were selected as risk factors associated with CVD. We conclude that significant hyperhomocysteinaemia is present in renal transplant recipients and represents a potential risk factor for cardiovascular disease in these patients.