Homocysteine and cardiovascular disease

Area of Science:

• Cardiovascular Medicine
• Clinical Biochemistry
• Nutritional Science

Background:

• Elevated total homocysteine (tHcy), or hyperhomocysteinemia, is increasingly recognized as a significant risk factor.
• It is linked to atherosclerotic vascular disease in coronary, cerebral, and peripheral vessels.
• It also contributes to arterial and venous thromboembolism.

Purpose of the Study:

• To summarize the evidence linking elevated tHcy to vascular disease and thromboembolism.
• To discuss the risk factors contributing to hyperhomocysteinemia.
• To evaluate the efficacy of B-vitamin supplementation in reducing tHcy levels.

Main Methods:

• Meta-analysis of approximately 80 clinical and epidemiological studies.
• Inclusion of data from over 10,000 patients.
• Review of genetic and acquired factors contributing to hyperhomocysteinemia.

Main Results:

• Elevated tHcy presents a graded, threshold-independent risk for vascular disease.
• This risk is independent of, but may potentiate, conventional cardiovascular risk factors.
• Hyperhomocysteinemia is a strong predictor of cardiovascular mortality.

Conclusions:

• Hyperhomocysteinemia is a prevalent risk factor for vascular and thromboembolic diseases.
• Common deficiencies in folate and vitamin B12 contribute to elevated tHcy.
• B-vitamin supplementation, particularly folic acid, effectively reduces tHcy and is being investigated for cardiovascular risk reduction.