Hyperhomocysteinaemia and poor vitamin B status in chronic obstructive pulmonary disease.

BACKGROUND AND AIMS: Patients with chronic obstructive pulmonary disease (COPD) are at increased atherothrombotic risk. Preliminary findings have suggested that COPD patients may have increased plasma total homocysteine (tHcy), a cardiovascular risk factor often caused by a poor B vitamin status, but plasma levels of such vitamins were not measured. The aim of this study was to investigate hyperhomocysteinaemia in COPD and to determine whether it may be secondary to poor plasma concentrations of B vitamins. METHODS AND RESULTS: We performed a case-control, cross-sectional study of 42 patients with COPD and 29 control subjects. Folate, vitamin B12, vitamin B6, tHcy, renal function, C-reactive protein, blood gases and lipids were measured in patients and controls. COPD patients had higher plasma tHcy (median: 13.9mumol/l, interquantile range [IQR]: 12.1-18.5 versus 11.5, IQR: 10.1-14, p=0.002) and lower circulating folate (median: 2.5ng/ml, IQR: 1.2-3.3 versus 2.8, IQR: 2.1-4 of controls, p=0.03) than controls had. Compared to the control group, COPD was associated with higher tHcy concentrations also after adjusting for smoking, heart failure, renal function and C-reactive protein with logistic regression analysis (OR 1.36, 95% CI 1.06-1.72, p=0.01). In the COPD group, low levels of folate (beta=-0.27, p=0.02) and vitamin B12 (beta=-0.24, p=0.04), and hypertriglyceridaemia (beta=0.580, p<0.0001) were independent predictors of the presence of high tHcy concentrations in a multiple linear regression model (adjusted R(2)=0.522). CONCLUSION: COPD patients have a poor B vitamin status and, as a consequence, increased tHcy. These abnormalities may contribute to the COPD-related atherothrombotic risk.

D-dimer assays in patients with carotid atherosclerosis in clinical practice.

BACKGROUND: Correlate D-dimer plasma values with the presence and degree of severity of atherosclerotic carotid lesions in consecutive outpatient and hospitalized patients without cardiovascular symptoms, checking to see if such correlation, if any, may be of help in daily clinical practice. METHODS: 113 consecutive outpatient and hospitalized patients (M/F 69/44; mean age +/- SD 66 +/- 11 years). EXCLUSION CRITERIA: acute arterial and venous thrombo-embolism, chronic venous insufficiency of lower limbs, active infections or inflammatory conditions, neoplasms, recent trauma or surgery. Ultrasonography of epiaortic vessels and quantitative assay of D-dimer using the ELFA method (Enzyme-Linked Fluorescent Assay) were carried out. RESULTS: The patients with carotid lesions at high thrombo-embolic risk had significantly higher D-dimer concentrations than those with normal IMT or with carotid presentation at low risk (1155 +/- 1099 ng/ml vs 359 +/- 121 ng/ml and 638 +/- 468 ng/ml; ANOVA p < 0.001). Among the patients at high thrombo-embolic risk, 85% had values higher than cut-off (vs 11.5% of patients with normal IMT and vs 45.5% of patients at low thromboembolic risk). CONCLUSIONS: D-dimer assay is a sound means for the study of angiology patients; normal D-dimer concentrations combined with modest lesions in the arterial wall are typical of patients at low thromboembolic risk. Monitoring this parameter may be useful between ultrasound tests. Significant increases over baseline values would prompt clinical intervention and justify additional diagnostic tests.

Relationships between serum hyperhomocysteinemia and carotid atherosclerosis in geriatric patients.

BACKGROUND: Evaluate the relationships between serum total hyperhomocysteinemia and carotid atherosclerosis. METHODS: The 102 consecutive patients over the age of 65 epiaortic vessels were examined by means of a high-resolution echo-Doppler and Doppler cw. Depending on the size of the atherosclerotic plaques in the carotid the patients were divided into two groups: a) patients with lesions at high thromboembolic risk (heterogeneous and/or ulcerated plaques, hemodynamically significant stenoses > 70%); b) individuals with low risk carotid involvement (IMT normal and/or thickened by > 0.8 mm and/or lumen stenosed by homogeneous plaques < 70%). The quantitative assay of serum total homocysteinemia (tHCY) was carried out by means of an immunofluorescent method (FPIA). Depending on their tHCY values, the patients were broken down into those with normal tHCY (cut-off 14 mumol/l for the women and 16 mumol/l for the men; 62 patients, M/F = 34/28, mean age 71 +/- 4); patients with mild hyperhomocysteinemia (tHCY 14-18 mumol/l for the women; 16-20 mumol/l for the men; 19 patients, M/F = 11/8; mean age 74 +/- 7); patients with moderate hyperhomocysteinemia tHCY 18 mumol/l for the women; > 20 mumol/l for the men; 21 patients, M/F = 18/3; mean age 74 +/- 7). RESULTS: As against the individuals with normal serum concentrations of HCY (Fig. 2; chi 2: p < 0.05), the patients with mild hyperhomocysteinemia (Odds ratio: OR = 1.48) and, above all, patients with moderate hyperhomocysteinemia (OR = 4.6) were found to have a greater prevalence of carotid lesions at high thromboembolic risk. No significant differences within the three groups were found with regard to distribution by age, gender and the prevalence of the more common cardiovascular risk factors (smoking, diabetes mellitus, arterial hypertension, hyperdyslipidemia). CONCLUSIONS: Hyperhomocysteinemia is associated with highly severe carotid lesions at higher risk for cerebrovascular events.