The case for mild hyperhomocysteinaemia as a risk factor

Area of Science:

• Cardiovascular Medicine
• Metabolic Disorders
• Epidemiology

Background:

• Severe hyperhomocysteinaemia is linked to vascular complications.
• Mild hyperhomocysteinaemia is increasingly recognized as an atherogenic and thrombophilic agent.
• Evidence suggests mild hyperhomocysteinaemia affects 20-30% of patients with vascular disease.

Purpose of the Study:

• To evaluate mild hyperhomocysteinaemia as an independent risk factor for vascular disease.
• To assess the synergistic interaction between hyperhomocysteinaemia and other cardiovascular risk factors.
• To demonstrate the relevance of hyperhomocysteinaemia through the European Comac study.

Main Methods:

• A multicentre case-control study ('Hyperhomocysteinaemia and Vascular Disease').
• Involved 800 vascular patients and 750 controls.
• Defined mild hyperhomocysteinaemia as the upper 20% of control homocysteine levels.

Main Results:

• Mild hyperhomocysteinaemia showed a relative risk of approximately 2 for arterial disease.
• This risk is comparable to hypercholesterolaemia and smoking.
• A synergistic interaction was observed between hyperhomocysteinaemia, hypertension, and smoking.

Conclusions:

• Mild hyperhomocysteinaemia is a significant, independent risk factor for vascular disease.
• Screening for hyperhomocysteinaemia should be considered even in the presence of conventional risk factors.
• Combined risk factors, including hyperhomocysteinaemia, may benefit from homocysteine-lowering interventions.