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Homocysteine

| What is homocysteine? |

| Excessively High Levels of homocysteine 
Hyperhomocysteinemia: a new risk factor for degenerative diseases.
|

| Effect of Homocysteine-Lowering Therapy | | Dosage

The Swiss Heart Study: A Randomized Controlled Trial 

Effect of Homocysteine-Lowering Therapy

With Folic Acid, Vitamin B12, and Vitamin B6 on Clinical Outcome After Percutaneous Coronary Intervention 

Guido Schnyder, MD; Marco Roffi, MD; Yvonne Flammer, MD; Riccardo Pin, MD; Otto Martin Hess, MD 

Context: Plasma homocysteine level has been recognized as an important cardiovascular risk factor that predicts adverse cardiac events in patients with established coronary atherosclerosis and influences restenosis rate after percutaneous (Cutting through the Skin) coronary intervention.

Objective: To evaluate the effect of homocysteine-lowering therapy on clinical outcome after percutaneous coronary intervention.

Design, Setting, and Participants Randomized, double-blind placebo-controlled trial involving 553 patients referred to the University Hospital in Bern, Switzerland, from May 1998 to April 1999 and enrolled after successful angioplasty of at least 1 significant coronary stenosis (50%) (stenosis: /stino'sis/, an abnormal condition marked by the tightening or narrowing of an opening or passageway in a body structure).

Intervention Participants were randomly assigned to receive a combination of:
bulletFolic acid (1 mg/d), 
bulletVitamin B12 (cyanocobalamin, 400 µg/d), and 
bulletVitamin B6 (pyridoxine hydrochloride, 10 mg/d) (n = 272) 
bullet or placebo (n = 281) .

for 6 months.

Conclusion

Homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 significantly decreases the incidence of major adverse events after  coronary intervention.

| Back to Top |



Hyperhomocysteinemia (Excessively High Levels of homocysteine) : 

A new risk factor for degenerative diseases.

Herrmann W, Knapp JP.Clin Lab 2002;48(9-10):471-81

Department of Clinical Chemistry, Saarland Medical School, Homburg/Saar, Germany. kchwher@uniklinik-saarland.de

Hyperhomocysteinemia (HHCY) is a consequence of disturbed methionine metabolism. It results from enzyme and/or vitamin deficiency. Epidemiological and clinical studies have proven HHCY to be an independent risk factor for atherosclerotic cardiovascular diseases, stroke, peripheral arterial occlusive disease and venous thrombosis. Trials in progress may clarify the "causality" of high homocysteine (HCY) concentrations and will assess the value of HCY lowering therapy. HHCY is also seen as a risk factor for neurodegenerative diseases such as cognitive impairment, dementia, Alzheimer's disease, and also for depression. There is a high prevalence of HHCY as a syndrome of vitamin shortage in elderly subjects, which strongly increases with advancing age. Elderly people have a high frequency of vitamin B12 deficiency which is more reliably diagnosed by measurement of serum methylmalonic acid and holotranscobalamin II, the metabolically active B12 fraction, than by total serum vitamin B12. Subjects who follow a strict vegetarian diet also have a high prevalence of HHCY caused by vitamin B12 deficiency. For prevention of neurological damages an early diagnosis of vitamin B12 deficiency is important. Furthermore, HHCY is a factor in the pathogenesis of neural tube defects and preeclampsia. HCY should be measured in patients with a history of atherothrombotic vessel diseases, in patients with diabetes or hyperlipidemia, in renal patients, in adipose subjects, in elderly people, in vegetarians, in postmenopausal women, and in early pregnancy.

PMID: 12389706 [PubMed - in process] 

| Back to Top |

What is homocysteine, and how is it related to cardiovascular risk?

Homocysteine (ho"mo-sis-TE'in) is an amino acid in the blood. Too much is related to a higher risk of coronary heart disease, stroke and peripheral (peh-RIF'er-al) vascular disease.

Two reports have strengthened the evidence for this relationship:

A large multi-center European trial found that men and women under 60 had a 2.2 times overall higher risk of cardiovascular disease if their plasma total homocysteine levels were in the top fifth of the normal range. This risk was independent of other risk factors but was notably higher in smokers and people with high blood pressure.


A Norwegian study of 587 patients with coronary heart disease found that their risk of death after four to five years was proportional to plasma total homocysteine levels. The risk rose from 3.8 percent in those with the lowest levels (below 9 micromol per liter) to 24.7 percent with the highest levels (greater than 15 micromol per liter). 
Other evidence suggests that homocysteine may promote atherosclerosis (ath"er-o-skleh-RO'sis) by damaging the inner lining of arteries and promoting blood clots. However, a causal link hasn't been established.


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