Significance of Plasma Homocysteine Concentration in Patients with Peripheral Arterial Disease

ABSTRACT

PURPOSE: Hyperhomocysteinemia has been identified as an important risk factor for coronary heart disease (CHD), cerebrovascular disease (CVD) and peripheral arterial disease (PAD). Previous reports have identified that elevated total homocysteine levels are associated with the development and progression of PAD, though little is known about its mechanism. Especially hyperhomocysteinemia is known to an independent risk factor for PAD. In this study, we examined the relationship between plasma homocysteine concentration and disease progression and disease severity in a patient with PAD. METHOD: We retrospectively analysed the clinical records of 65 patients, who were diagnosed with arteriosclerosis obliterans, for sex, mean homocysteine concentration, relationship between plasma homocysteine concentration and disease severity and disease progression at Kyung-Hee University Hospital from January 2002 to December 2003. Homocysteine level of 28 healthy adults was measured to identify normal value. Hyperhomocysteinemia was defined as a plasma homocysteine concentration exceeding the 95th percentile of the control group (> or =13.8mumol/L). RESULT: The study group comprised 56 men (86.29%) and 9 (13.8%) women. The mean plasma homocysteine concentration was higher in study group than in controls (11.4mumol/L vs. 10.03.mumol/L, P=0.06). Hyperhomocysteinemia was significantly more common in the disease progression groups (P=0.028). Mean plasma homocysteine concentrations associated with disease severity, according to the Rutherford classification, were 8.33mumol/L, 9.59mumol/L, 12.64 mumol/L and 14.17mumol/L at Grades 0, I, II and III, respectively. The high grade patients were significantly more likely to have high plasma homocysteine concentration (P=0.04). Plasma homocysteine concentration according to associated disease was 10.79mumol/L in patients with PAD alone, 10.88 mumol/L in patients with CVD, 15.02mumol/L in patients with CHD, and 14.99mumol/L in patients with both CVD and CHD. In patients associated with CHD, plasma homocysteine concentration was significantly higher (P=0.035). CONCLUSION: In this study, plasma homocysteine concentration was higher in patients with PAD than in controls. Especially, there was a high rate of hyperhomocysteinemia in patients associated with CHD. Progression of PAD was more likely in patients with elevated plasma homocysteine. The high-grade patients were more likely to have high plasma homocysteine concentration. Therefore, the measurement of plasma homocysteine concentration in patients with PAD is expected to be useful in making prognosis. However, a prospective, randomized study is necessary to prove the effect of homocysteine-lowering therapy in delaying disease progression.