Association between Plasma Homocysteine Level and Brachial-ankle Pulse Wave Velocity in Korean Adults / 가정의학회지

BACKGROUND: Elevated plasma homocysteine appears to be causally related to atherosclerosis by inducing both endothelial dysfunction and vascular structure alteration. Brachial-ankle pulse wave velocity, a non-invasive means of measuring atherosclerosis, reflects arterial stiffness. In this study, we investigated the association between the plasma homocysteine level and arterial stiffness in Korean adults. METHODS: The study group comprised of 405 subjects selected from examinees in the Health Promotion Center. Medical history, medication, and life style were recorded through a questionnaire and physical examination was performed on all subjects. We measured glucose tolerance index, lipid profile, inflammatory index, and plasma homocysteine level. We studied brachial-ankle pulse wave velocity (baPWV) as a measure of arterial stiffness. RESULTS: A total of 379 subjects were examined on all components. The mean age in 172 males was 54.5 +/- 8.7 years and in females was 57.2 +/- 7.0 years. The baPWV was observed to be positively correlated with age, blood pressure, hs-CRP, and homocysteine in males. In contrast, males, age, BMI, waist circumference, blood pressure, glucose tolerance index, lipid profile except for HDL cholesterol, hs-CRP, and homocysteine were positively correlated with baPWV in females. The baPWV was increased according to the level of plasma homocysteine in males. After ontrolling or risk factors of cardiovascular diseases, homocysteine was associated with increased baPWV CONCLUSION: The results indicate that elevated plasma homocysteine was associated with baPWV in middle-aged male after adjustment for the risk factors of cardiovascular diseases.

Relationship between Insulin Resistance and Circulating Levels of Monocyte Chemoattractant Protein?1 in Healthy Adults

BACKGROUND: Insulin resistance is one of the underlying causes for atherosclerosis. The monocyte chemoattractant protein-1 (MCP-1) plays a crucial role in initiating atherogenesis by recruiting monocytes/macrophages to vessel wall. In this study, we investigated the relationship between homeostasis model assessment-estimated insulin resistance (HOMA-IR) and circulating level of MCP-1 in healthy adults. METHODS: By reviewing the medical records of 171 healthy adults, we determined the circulating level of MCP-1, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL- cholesterol, HDL-cholesterol, fasting glucose, fasting insulin level and HOMA-IR. We studied the relationship between the variables by Pearson correlation coefficients and multiple linear regression analysis. RESULTS: MCP-1 correlated positively with HOMA-IR (r=0.28; P<0.01). Age, systolic blood pressure, diastolic blood pressure, triglycerides, LDL-cholesterol, fasting glucose and insulin level also showed stastically significant correlation. Age, gender, HOMA-IR were the variables which affected MCP-1 by multiple regression analysis adjusting for body mass index, systolic blood pressure, triglycerides, and LDL-cholesterol. CONCLUSION: In our study, circulating levels of MCP-1 were associated with insulin resistance. These findings support the potential role of MCP-1 as a biomarker for subclinical atherosclerosis.

Association between Metabolic Syndrome and Plasma Homocysteine among Korean Adults

BACKGROUND: Elevated plasma homocysteine is an independent risk factor for cardiovascular diseases caused by atherosclerosis. Previous studies have shown that plasma homocysteine is associated with components of the metabolic syndrome such as hypertension, insulin resistance, and dyslipidemia. In this study, we investigated the association between the plasma homocysteine levels and the metabolic syndrome on Korean adults. METHODS: The study group with the metabolic syndrome and the control group without the metabolic syndrome were selected from the examinees of equivalent age and gender in the Health Promotion Center. Among the subjects, 107 adults with the metabolic syndrome and 123 adults without the metabolic syndrome were categorized into the study and the control groups, respectively. Medical history, medication, and life style were recorded through a questionnaire and physical examination was performed on all subjects. We measured fasting glucose, total cholesterol, triglycerides, high-density lipoprotein, hs-CRP, homocysteine levels and others by blood sampling. The metabolic syndrome was defined by the criteria for clinical diagnosis of the metabolic syndrome by AHA/NHLBI. RESULTS: The mean ages in the study group and the control group were 54.6+/-9.3 and 54.6+/-8.7 years, respectively, and the numbers of males 29 (27.1%) and 39 (31.7%), respectively. The plasma homocysteine was observed to be positively correlated with age, waist circumference, diastolic blood pressure, apolipoprotein A-1, fasting glucose, fasting insulin, HOMA-IR, and hs-CRP. Among the components of the metabolic syndrome, hypertension showed a strong correlation with the levels of the plasma homocysteine (10.62+/-3.92 micronmol/L vs. 9.09+/- 2.63 micronmol/L, P=0.001), whereas hyperglycemia, abdominal obesity, and dyslipidemia did not correlate with the levels of plasma homocysteine. Adjusted homocysteine levels to age, gender, alcohol drinking history, and smoking history was still higher in the study group compared to those in the control group (10.320+/-0.290 micronmol/L vs. 10.320+/-0.290 micronmol/L, P=0.017). CONCLUSION: The results indicate that the metabolic syndrome leads to a higher level of homocysteine in adults after adjustment to age, gender, alcohol drinking history, and smoking history.

A Case of Aortopulmonary Septal Defect

Aortopulmonary septal defect is a rare congenital cardiac anomaly. A 15 year old boy was admitted to Department of Internal Medicine of Seoul National University Hospital because of exertional dyspnea. Aortopulmonary septal defect was confirmed by cardiac catheterization demonstrating severe pulmonary hypertension and patent foramen ovale, and retrograde aortogram showing contrast material passing from the ascending aorta just above the aortic valve into the pulmonary trunk. We present a case of aortopulmonary septal defect with a review of literatures.