Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors / Hiper-homocisteinemia como fator de risco independente para doença coronariana: comparação com fatores de risco convencionais

Abstract The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

Resumo O presente estudo foi desenhado para avaliar a força da associação da concentração elevada de homocisteína no plasma como um fator de risco para doença cardíaca coronária independente do fator de risco convencional. Foi um estudo de caso-controle realizado no Punjab Institute of Cardiology Lahore. Um total de 210 indivíduos com idade entre 25 e 60 anos, compreendendo 105 pacientes recém-admitidos de CHD como casos e 105 indivíduos saudáveis ​​pareados por idade e sexo sem histórico de CHD como controle, foi recrutado para o estudo. Amostras de sangue em jejum foram obtidas de casos e controles. A homocisteína plasmática foi analisada pelo método de imunoensaio de polarização de fluorescência (FPIA) em analisador de imunoensaio automatizado (Abbott IMX). Colesterol total, triglicerídeos e colesterol HDL foram analisados ​​usando métodos de kit calorimétrico. A concentração de colesterol LDL foi calculada pela fórmula de Friedewald. Os pacientes também foram avaliados para fatores de risco tradicionais, como idade, sexo, história familiar de DCV, hipertensão, tabagismo e atividade física, e foram comparados com indivíduos de controle. Os dados coletados foram inseridos no SPSS versão 24 para análise e interpretação. A média de idade nos grupos controles e experimentais foi de 43,00 ± 8,42 anos e 44,72 ± 8,59 anos com distribuição estatisticamente igual (p-valor = 0,144). A homocisteína plasmática média para os casos foi de 22,33 ± 9,22 µmol / L, enquanto no grupo controle foi de 12,59 ± 3,73 µmol / L. Diferença altamente significativa foi observada entre o nível plasmático médio de homocisteína em casos e controles (p ˂ 0,001). A regressão logística simples indica uma forte associação de doença cardíaca coronária com hiper-homocisteinemia (OR 7,45), que permaneceu significativamente associada com doença cardíaca coronária por multivariada regressão logística (OR 7,10, 95% C1 3,12-12,83, p = 0,000). O presente estudo conclui que níveis elevados de homocisteína plasmática são fator de risco independente para doença cardíaca coronária, independentemente dos fatores de risco convencionais, e pode ser usado como um indicador para prever a possibilidade futura de aparecimento de DCV.

Association Between Plasma Homocysteine Level and Hyperuricemia in Elderly Patients With Hypertension / 中国医学科学院学报

Objective To explore the association between plasma homocysteine (Hcy) level and hyper-uricemia (HUA) in the elderly patients with hypertension.Methods From March to August in 2018,9902 hypertensive patients ≥ 60 years were routinely tested for blood biochemical indicators in Wuyuan county,Jiangxi province.The patients were assigned into a HUA group and a normal uric acid group.Multivariate Logistic regression was adopted to analyze the relationship between Hcy level and the risk of HUA.Results Compared with the normal uric acid group,the HUA group showed increased incidence of hyperhomocysteinemia (99.9% vs.98.7%,P<0.001) and elevated Hcy level[16.8 (13.8-21.5) μmol/L vs.14.4 (12.3-17.7) μmol/L,P<0.001].The multivariate Logistic regression analysis showed that after adjusting for influencing factors,the risk of HUA in the patients with hyperhomocysteinemia was 2.92 times of that in the patients with a normal Hcy level.The threshold effect analysis showed that the Hcy level was positively correlated with the occurrence of HUA in the case of Hcy<20 μmol/L (OR=1.05,95%CI=1.04-1.07,P<0.001).In the case of Hcy ≥ 20 μmol/L,there was no correlation between Hcy level and HUA (OR=1.00,95%CI=0.99-1.00,P=0.055),and the likelihood ratio test showed statistically significant results (P<0.001).Conclusion The elderly with hypertension should pay attention to control the Hcy level,which will be helpful to prevent the occurrence of HUA.

Status of hyperhomocysteinemia in China: results from the China Stroke High-risk Population Screening Program, 2018 / 医学前沿

A nationwide survey was conducted from October 2018 to September 2019 to assess the prevalence of hyperhomocysteinemia (Hhcy) and its influencing factors in China. A standardized questionnaire was used to collect information. Hhcy was defined as the level of serum homocysteine (HCY) ⩾ 15.0µmol/L. The H-type hypertension (HHYP) was defined as hypertension with an elevated serum HCY 15.0µmol/L). Finally, 110 551 residents ⩾ 40 years of age from 31 provinces in the mainland of China were included. Overall, the median serum HCY level was 10.9µmol/L (interquartile range 7.9-15.1). A total of 28 633 participants (25.9%) were defined as Hhcy. The Hhcy prevalence ranged from 7.9% in Shanghai to 56.8% in Tianjin. The data showed that serum HCY levels were associated with age, male gender, cigarette smoking, hypertension, diabetes, ethnicity, endurance in exercise (inverse), and fruit and vegetable intake (inverse). In addition, 15 486 participants were defined as HHYP, and the rate was 14.0%. HHYP was an independent predictor of stroke with an adjusted odds ratio of 1.752 (95% CI 1.338-2.105). The geographical distribution pattern of the Hhcy epidemic reflects dynamic differences, and national strategies should be carried out to further improve the care of patients with Hhcy across China.

Exploration of the risk factors of essential hypertension with hyperhomocysteinemia: A hospital-based study and nomogram analysis

OBJECTIVES: To explore the risk factors of essential hypertension with hyperhomocysteinemia (H-type hypertension) and design a nomogram to predict this risk. METHODS: A hospital-based study was conducted on 1,712 individuals, including 282 patients with H-type hypertension, 105 patients with simple hypertension, 645 individuals with hyperhomocysteinemia, and 680 healthy controls. Logistic regression and nomogram models were applied to evaluate the risk factors. RESULTS: Logistic regression showed that advanced age, male sex, high body mass index (BMI), high total cholesterol levels, high glucose levels, and high creatinine levels were risk factors of H-type hypertension in the healthy population and were integrated into the nomogram model. Advanced age, male sex, high BMI, high total cholesterol levels, and high glucose levels were shown to be risk factors of H-type hypertension in the hyperhomocysteinemia population. Male sex and high creatinine levels were shown to be risk factors of H-type hypertension in the hypertension population. Nomogram analysis showed that the total factor score ranged from 106 to 206, and the corresponding risk rate ranged from 0.05 to 0.95. CONCLUSIONS: Men are more likely to have H-type hypertension, and advanced age, high BMI, high total cholesterol levels, and high glucose levels are risk factors of H-type hypertension in healthy and hyperhomocysteinemia populations. Furthermore, high creatinine level is a risk factor of H-type hypertension in healthy and hypertension populations. Nomogram models may be used to intuitively evaluate H-type hypertension risk and provide a basis for personalized interventions.

Study on relationships among deep vein thrombosis, homocysteine and related B group vitamins

Hyperhomocysteinemia has been considered as a potential risk factor for deep venous thrombosis [DVT] but it is still controversy. We aimed to evaluate the prevalence of hyperhomocysteinemia in patients with DVT. Our second objective was to document the prevalence of folate, Vitamin B6, and Vitamin B12 level in this patient population. Sixty patients with DVT aged from 23 to 84 years, were assessed regarding demographic characteristics, serum levels of homocysteine, folate, vitamin B12, and vitamin B6. The diagnosis of DVT was based upon Wells scoring system and serum D-dimer level and confirmed by deep venous Doppler ultrasonography of the lower limbs. Mean serum homocysteine levels were found significantly higher in patients over the age of 40 years [10.81 +/- 4.26 micromol/L vs 9.13 +/- 3.23 micromol/L]. Of all the patients, 9 patients had homocysteine level above the 15 micromol/L, 26 had folic acid level below 3 ng/ml, one had vitamin B12 level below 150 pmol/L, and two had vitamin B6 level below 30 nmol/L. In the hyperhomocysteinemic group, five patients had low folic acid level, one had low vitamin B12 level, and two had low vitamin B6 level. Hyperhomocysteinemia, in women older than 40 years, may be a risk factor for DVT. Folic acid deficiency may also influence serum homocysteine concentrations. Folate therapy may be offered to the patients with DVT. However further studies are required to clarify the underlying molecular mechanisms

Influence of folic acid on plasma homocysteine levels & arterial endothelial function in patients with unstable angina.

Background & objectives: High plasma homocysteine (Hcy) levels are known to be associated with coronary artery disease, but the precise level associated with an increased risk is yet controversial. Whether the beneficial effects of folic acid on arterial endothelial function persist over longer periods is not known. This study was carried out to assess whether folic acid supplementation could produce improvements in Hcy levels and arterial endothelial function in the patients with unstable angina (UA) and hyperhomocysteinaemia. Methods: The plasma Hcy levels of 52 cases with UA and 30 control subjects were measured by using high-performance liquid chromatography (HPLC) with fluorescence detection, plasma folic acid and vitamin B12 levels were also measured. The patients with hyperhomocysteinaemia were treated with 5 mg of folic acid for 8 wk, and then rechecked the plasma levels of Hcy, folic acid and vitamin B12 at the end of 4th and 8th wk. Arterial endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution B-mode ultrasound in 22 cases with UA and hyperhomocysteinaemia before and after folic acid treatment. Results: The plasma Hcy level was significant higher in the patients with UA than in the controls (19.2 ± 4.9 vs 10.7 ± 5.3 μmol/l, P<0.01). The plasma levels of folic acid and vitamin B12 were significant lower in the patients with UA than in the controls. There were 22(42.3%) patients with hyperhomocysteinaemia in UA group. After 4 and 8 wk of administration of folic acid, the Hcy level reduced by 20.3 and 55.3 per cent in the UA patients with hyperhomocysteinaemia, respectively. Flow-mediated dilation also improved significantly, from 6.4 ± 1.9 to 9.0 ± 1.2 per cent (P<0.05) after 8 wk treatment with folic acid. Interpretation & conclusions: Plasma Hcy level was elevated in patients with UA. Folic acid can reduce the plasma Hcy levels and improve arterial endothelial function in the UA patients with hyperhomocysteinaemia.

Hypercoagulable state in idiopathic ulcerative colitis: role of hyperhomocysteinemia and hyperfibrinogenemia.

BACKGROUND: Previous reports on hypercoagulable factors in inflammatory bowel diseases involve heterogeneous populations and patients on various medications. AIMS: To determine the frequency of thrombotic complications in ulcerative colitis (UC); to evaluate for hyperhomocysteinemia and its relationship to vitamin B12 and folate levels and methylene tetrahydrofolate reductase (MTHFR) mutation; and to evaluate for hyperfibrinogenemia and factor V Leiden mutation. METHODS: Eighty-six adult patients with UC were seen during the study period; 28 of them underwent blood tests and constituted the study population. Patients who received medications that affect these factors were among the 58 excluded. Tests were obtained at baseline and after 2 months during remission. Patients received folic acid in addition to treatment for UC. RESULTS: Vascular thrombotic events were noted in 4 patients during follow up. Hyperhomocysteinemia was detected in 11 (39.3%) patients (controls 15/100, p=0.007). Heterozygous state for MTHFR C677T mutation was found in 5 (17.9%) patients (controls: 0.2% homozygous, 13.6% heterozygous, p>0.05). Plasma homocysteine did not correlate with extent, severity or duration of disease, or with MTHFR C677T heterozygous state, but correlated with serum folic acid level (p=0.003) and BMI (p=0.03). With folate supplementation, homocysteine decreased significantly in patients who had hyperhomocysteinemia at baseline. Hyperfibrinogenemia was detected in 3 patients (none in 100 controls). Plasma fibrinogen was not affected by duration, extent or severity of UC and did not decrease with remission of disease. Only one patient had heterozygous factor V Leiden mutation. CONCLUSION: Vascular thrombosis occurred in less than a fifth of the UC population studied. Hyperhomocysteinemia reversible by folate supplementation and hyperfibrinogenemia were observed, but their contribution and that of factor V Leiden mutation appear to be insignificant.

Hyperhomocysteinemia and cardiovascular diseases in Algeria people

Epidemiological research has shown that elevated total homocysteine [thcy] is a risk factor for atherosclerosis disease. This study was carried in symptomatic patients with cardiovascular disease n= 63 and asymptomatic n= 27. There was a significant decrease in Total-cholesterol [3.65mmol/l +/- 1.25] and HDL-cholesterol [0.84mmol/l +/- 0.48] in symptomatic patients and compared with asymptomatic the concentration of Total-cholesterol was [4.12mmol/l +/- 0.84] and HDL-cholesterol was [1.17mmol/l +/- 0.54]. The concentration of enzymes LDH, CK and ALP [271.47units/l +/- 129.18, 121.34units/l +/- 142.50 and 232.57units/l +/- 95.72], respectively in symptomatic patient and in asymptomatic control group were [170units/l +/- 46.3, 74.3units/l +/- 38.5 and 50 and 132.73units/l +/- 59.81], respectively, these values are increased significantly between two groups. The main values of thiols [homocysteine; cysteinylglycine, glutathione oxidized and reduced] were higher in patients with cardiovasculardisease [10.21micro mol/l +/- 5.59, 32.38 micro mol/l +/- 22.34, 17.91 micro mol/l +/- 8.83 and 32.96 micro mol/l +/- 17.34], respectively than in asymptomatic subjects where the concentration of thiols were [7.67 micro mol/l +/- 2.66, 25.48 micro mol/l +/- 11.11, 6.66 micro mol/l +/- 2.79 and 12.09 micro mol/l +/- 5.18]. The main value of homocysteine [12.89 micro mol/l +/- 4.59] was increased highly and significantly in symptomatic postmenopausal women in contrast to homocysteine concentration [8.45 micro mol/l +/- 4.94] in male patients. Our study suggests that plasma level total homocysteine is an independent risk factor in atherogenic process

Avaliação dos níveis séricos de homocisteína em transplantados renais com e sem hipercolesterolemia / Serum homocysteine levels in renal transplant recipients with and without hypercholesterolemia

FUNDAMENTO: A ocorrência de hiper-homocisteinemia parece ser freqüente após o transplante renal. Nenhum estudo até o momento avaliou o papel da homocisteína (Hcy) associada à dislipidemia no Brasil. OBJETIVO: Determinar a prevalência de hiper-homocisteinemia (Hcy sérica >15 mmol/l) em pacientes estáveis submetidos a transplante renal e avaliar o papel dos lipídios séricos e da função do enxerto nos níveis de Hcy sérica. MÉTODOS: Cento e cinco pacientes estáveis submetidos a transplante renal foram avaliados, levando-se em consideração idade, tempo pós-transplante, níveis séricos de colesterol, função do enxerto, proteinúria e uso de ciclosporina (analisados por regressão linear múltipla). A prevalência de hiper-homocisteinemia foi de 74,3 por cento. Os pacientes foram divididos em dois grupos: hipercolesterolêmicos (colesterol total > 200 mg/dl, colesterol LDL > 130 mg/dl) e normocolesterolêmicos. RESULTADOS: Os pacientes hipercolesterolêmicos eram mais velhos, tinham menor tempo pós-transplante, menor depuração de creatinina endógena, maior proteinúria e níveis séricos mais elevados de Hcy. Os pacientes com hiper-homocisteinemia tinham níveis séricos de triglicérides significativamente mais elevados e função do enxerto significativamente pior; além disso, seus níveis de colesterol LDL apresentaram tendência a ser mais elevados. Houve uma correlação positiva entre os níveis séricos de creatinina e de Hcy (r = 0,32; p = 0,01). A análise de regressão linear múltipla revelou que tanto a dislipidemia quanto a função renal afetam de forma independente os valores de Hcy. CONCLUSÃO: Observamos uma alta prevalência de hiper-homocisteinemia em pacientes submetidos a transplante renal, especialmente em hipercolesterolêmicos, sugerindo que uma pior função do enxerto pode influenciar negativamente os níveis séricos de Hcy e colesterol. Estudos futuros deverão investigar se esse perfil metabólico adverso está associado com maior mortalidade cardiovascular...

BACKGROUND: Hyperhomocysteinemia seems to be frequent after renal transplantation. No study so far has assessed the role of homocysteine (Hcy) associated with dyslipidemia in Brazil. OBJECTIVE: To determine the prevalence of hyperhomocysteinemia (serum Hcy >15 mmol/l) in stable renal transplant recipients and to evaluate the role of serum lipids and graft function in serum Hcy levels. METHODS: One hundred and five stable renal transplant recipients were evaluated, considering age, post-transplant time, cholesterol levels, graft function, proteinuria, and cyclosporine (analyzed using multiple linear regression). The prevalence of hyperhomocysteinemia was 74.3 percent. Patients were further divided into two groups, hyper (total cholesterol >200mg/dl, LDL-cholesterol >130mg/dl) and normocholesterolemic. RESULTS: Hypercholesterolemic recipients were older, had shorter post-transplant time, lower endogenous creatinine clearance, and higher proteinuria and Hcy serum levels. Patients with hyperhomocysteinemia had statistically significantly higher serum triglycerides and poorer graft function, and their LDL-cholesterol also tended to be higher. A positive correlation was found between serum creatinine and Hcy levels (r = 0.32, P = 0.01). Multiple regression analysis revealed that both dyslipidemia and renal function independently affect Hcy values. CONCLUSION: We observed a high prevalence of hyperhomocysteinemia in renal transplant recipients, especially in hypercholesterolemic, suggesting that worse graft function may influence serum Hcy and cholesterol levels negatively. Further studies should investigate if this adverse metabolic profile is associated with higher cardiovascular mortality in the long term.

Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians.

BACKGROUND: Low vitamin B12 concentration in South Asian Indians is common, but the exact prevalence is not known. AIM: To investigate prevalence and associations of low vitamin B12 concentration and hyperhomocysteinemia in rural and urban Indian men living in and around Pune, Maharashtra. METHOD: We studied 441 middle-aged men (149 rural, 142 slum and 150 urban middle-class residents, mean age 39 y). Data on lifestyle, socio-economic status, nutrition and medical history were obtained. Circulating concentrations of vitamin B12, folate, ferritin, total homocysteine (tHcy), and haematological indices, and cardiovascular risk variables were measured. RESULTS: Median plasma B12 concentration was low (110 pmol/L): Overall, 67% of men had low vitamin B12 concentration (<150 pmol/L) and 58% had hyperhomocysteinemia (>15 micromol/L). Of the urban middle class, 81% had low vitamin B12 concentration and 79% had hyperhomocysteinemia. Low vitamin B12 concentration contributed 28% to the risk of hyperhomocysteinemia (population attributable risk) while low red cell folate contributed 2%. Vegetarians had 4.4 times (95% CI 2.1, 9.4) higher risk of low vitamin B12 concentrations and 3.0 times (95% CI 1.4, 6.5) higher risk of hyperhomocysteinemia compared to those who ate non-vegetarian foods frequently. Urban middle-class residence was an additional independent risk factor of hyperhomocysteinemia (odds ratio 7.6 (95% CI 2.5, 22.6), compared to rural men). Low vitamin B12 concentration was related to lower blood haemoglobin concentration and higher mean corpuscular volume, but macrocytic anemia was rare. CONCLUSION: Low vitamin B12 concentration and hyperhomocysteinemia are common in Indian men, particularly in vegetarians and urban middle class residents. Further studies are needed to confirm these findings in other parts of India.

Evaluation of total plasma homocysteine in Indian newborns using heel-prick samples.

OBJECTIVE: To estimate total plasma homocysteine levels in Indian newborns by modifying the existing SBD-F based High performance liquid chromotography (HPLC) method in order to enable analysis in newborn heel-prick samples and assess the prevalence of hyperhomocysteinemia in Indian newborns who are exclusively breast-fed. METHODS: Reverse-phase HPLC with fluorescence detection for plasma homocysteine estimation and statistical analysis using student t-test. RESULTS: SBD-F based HPLC method was modified and Bland and Altman analysis was carried out to assess agreement between original and modified methods. The correlation co-efficient was 0.994. The limits of agreement (-5.9, 6.3) were small enough to apply new method in place of the old for heel-prick sample analysis. Total plasma homocysteine analysis was carried out on heel-prick samples of 607 randomly selected newborns (331 males and 276 females). The mean plasma homocysteine estimated by this method in Indian newborns was 6.99 (95% CI: 6.48-7.49) with no appreciable gender effect (P=0.74). Elevated homocysteine levels were observed in 31 males and 21 females. CONCLUSIONS: Modified HPLC method is validated and can be used for homocysteine analysis on newborn heel-prick samples. Using this method, the prevalence of hyperhomocysteinemia in Indian newborns is 8.6%.

Hiper-homocisteinemia como fator de risco para doença aterosclerótica coronariana em idosos / Hyperhomocysteinemia as a risk factor for coronary atherosclerotic diseases in the elderly

OBJETIVO: Investigar se a hiper-homocisteinemia é fator de risco independente para doença aterosclerótica coronariana em idosos. MÉTODOS: Estudo caso-controle com 172 idosos, 88 pertencentes ao grupo controle e 84 ao grupo caso, que apresentavam cineangiocoronariografia solicitada por indicações clínicas. Angiografia coronariana quantitativa foi realizada em 91 por cento dos pacientes. Homocisteinemia foi avaliada sob forma contínua e categorizada, por análise univariada e multivariada. RESULTADOS: Quando analisada sob forma contínua, verificou-se que, na análise univariada, os idosos do grupo caso apresentaram média de níveis de homocisteinemia significativamente mais elevada que a dos idosos do grupo controle (14,33±4,59 æmol/l versus 11,99± 4,59 æmol/l , p=0,015). Na análise multivariada, a homocisteinemia sob forma contínua associou-se a razão de risco para doença arterial coronariana de 1,07 a cada aumento de 1 æmol/l de nível de homocisteína. Aumento de 5 æmol/l correspondeu a razão de risco de 1,40. Quando analisada sob forma categorizada, definiu-se como hiper-homocisteinemia os valores encontrados acima do percentil 75 do grupo controle (14 æmol/l ). Hiper-homocisteinemia foi encontrada em 34 por cento dos idosos, sendo 37,3 por cento no grupo controle e 62,7 por cento no grupo caso (p=0,009). Na análise multivariada, a hiperhomocisteinemia constituiu fator de risco independente para doença aterosclerótica coronariana em idosos, com razão de risco para doença arterial coronariana de 2,03, intervalo de confiança 95 por cento, 1,02-4,03. CONCLUSAO: Hiper-homocisteinemia foi fator de risco independente para doença arterial coronariana em idosos.

Serum homocysteine concentration in patients with acute MI and chronic IHD.

This was an observational study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; with the active co-operation of Coronary Care Unit (CCU) of BSMMU & National Institute of Cardiovascular Disease (NICVD), Dhaka. This study was carried out from March 2002 to January 2003. Total seventy (70) subjects were studied. Out of them 20 were of Acute MI, 20 were Chronic ischemic heart disease (CHD) and 30 were age and sex matched healthy controls. Hospitalized diagnosed patients were selected by taking history, clinical examination and several investigations like ECG. Echocardiogram, Angiogram and several enzymes assay. Several studies in many countries showed that serum homocysteine (Hcy) was elevated in IHD Patient. Cardiovascular disease is alarmingly increasing in Bangladesh. So our aim and objective of the study was to find out the association of serum Hcy with Acute MI and chronic ischemic heart disease (CHD) patients in our population. Mean Hcy level of Acute MI were 21.16 +/- 4.56 (micromol/l), 27.55 +/- 10.40 (micromol/l) and that of control was 13.03 +/- 10.51(micromol/l). Serum Hcy was significantly higher in both cases than control. But insignificant difference was found between AMI vs CHD (P> 0.05). Quantitative measurement of serum Hcy was measured by fluorescence polarization Immunoassay (FPIA) in IMX analyzer (Abbott-USA).

Hyperhomocysteinaemia in Sri Lankan patients with coronary artery disease.

OBJECTIVE: To determine the association between hyperhomocysteinaemia and coronary artery disease (CAD) in a sample of Sri Lankans. DESIGN: A case control study. SETTING: Asiri Hospital, Kirula Road, Colombo 5, Sri Lanka. SUBJECTS: 105 patients with coronary artery disease and 112 controls. METHOD: Fasting serum homocysteine levels were measured in 105 patients diagnosed as having CAD and in 112 unmatched controls. All patients admitted with clinical, electrocardiographical, biochemical or echocardiographical evidence of CAD were included in the study. Controls were selected from subjects admitted for health screening. RESULTS: 105 patients with CAD and 112 controls (unmatched for age and sex) were studied. A serum homocysteine level in excess of 18.2 mumol/l was considered high. Confounding effects of other conventional risk factors for CAD were controlled using multivariate logical regression analysis. CONCLUSION: Hyperhomocysteinaemia is significantly associated with CAD. Multivariate logistic regression analysis indicated that the association between hyperhomocysteinaemia and CAD was confounded by other risk factors. However, statistical analysis revealed a significant independent association between hyperhomocysteinaemia and CAD (adjusted odds ratio = 2.881).

Prevalence of hyperhomocysteinemia in normal healthy Thai subjects.

The concentration of circulating total homocysteine is a sensitive marker of inadequate folate and vitamin B12 status. The elevations of plasma homocysteine concentration are associated with an increased risk of vascular disease. The primary goals of this study were to identify plasma homocysteine concentrations in Thai residents and to test for differences in homocysteine levels among sex and age categories. The authors measured plasma total homocysteine concentrations in 3,345 Shinawatra employees (1,133 males, 2,212 females aged between 20-65 years) by using fluorescence polarization immunoassay (FPIA) method. The mean plasma homocysteine concentrations of males and females were 11.495 and 8.547 micromol/L respectively. Plasma homocysteine concentrations were significantly lower in females than in males (p < 0.0001). The age-specific plasma homocysteine levels were lower in females than in males for each group, but the levels of each group was not significantly different both in males and females. When more than 12 micromol/L was used as the cut-off value, it was found that 33.6 per cent of males and 6.69 per cent of females were classified as hyperhomocysteinemia subjects. The authors concluded that the prevalence of hyperhomocysteinemia in Thai males is more common than in females. Further investigation should be done to clarify the association between serum folate, vitamin B12, vitamin B6 concentrations and plasma homocysteine concentration.