Homocysteine a risk factor for cardiovascular disease in patients with type 2 diabetes mellitus

ABSTRACT

Diabetes mellitus has been widely recognized as major risk factor for coronary artery disease and, at the present time, diabetics are considered at high risk for coronary events independently of prior evidence of atherosclerotic disease [1]. Hyperhomocysteinemia has emerged as a novel risk factor for myocardial infarction. Diabetes shares many common mechanisms of plaque development with hyperhomocysteinemia, such as those related to endothelial dysfunction, thrombosis and oxidative stress [2]. To study the importance of serum homocysteine [Hcy] level as a predictor of myocardial infarction in patients with type 2 diabetes mellitus and to detect that this level is of an equal importance as other cardiovascular risk factors such as hypertension, hypercholesterolemia and smoking. Forty individuals were divided into three groups group I [acute myocardial infarction with type 2 diabetes group, n=15], group II [uncomplicated type 2 diabetes group, n=15] and group III [normal control, n=10]. Diagnosis of myocardial infarction was confirmed from ECG criteria together with significant elevations in serum creatine kinase activity and echocardiographic examination. Higher homocysteine levels was found in AMI patients with type 2 diabetes and in uncomplicated type 2 diabetic patients [P< 0.01] than the normal control. Homocysteine was positively associated with total cholesterol, LDL-c, P.PB.S, and negatively associated HDL-c. Higher homocysteinemia was predominantly observed in type 2 diabetic patients with myocardial infarction especially those presenting low HDL-c, high LDL-c. Serum homocysteine is considered to be one of the strong and important predictor of myocardial infarction in type 2 diabetes