Association of Hyperhomocysteinemia with Acute Myocardial Infarction in Kurdish Patients

Abstract

Cardiovascular disease (CVD) is the main cause of death worldwide. Among multiple cardiovascular risk factors, such as age, blood pressure, diabetes, smoking and hyperlipidemia, hyperhomocysteinemia has recently emerged to have an important role in increasing risk of CVD by impairing oxidative stress-induced endothelial dysfunction and inducing atherothrombosis. However, the association between high circulating level of homocysteine and increasing the risk of CVD in human remains controversial and has not been consistently observed. OBJECTIVES: The aim of this study is to evaluate the association between serum total homocysteine (tHcy) concentrations with increased risk of CAD in patients with acute myocardial infarction (MI) in Kurdish population. In addition, correlations of classical risk factors including hypertension, smoking, diabetes and hyperlipidemia with hyperhomocysteinemia in MI patients were studied. Its role in in development of CVD could be pivotal. METHODS: In a case-control study, a total of 74 patients (51 male; 23 female; aged 22-80 years) who had diagnosed with acute CAD on angiography were enrolled in this study and 74 gender and age matched non-CAD individuals were included as the control group. The serum tHcy level was measured by enzymatic immunoassay. Hyperhomocysteinemia (HHcy) was defined as Hcy>15 µmol/l. RESULTS: the mean ± standard deviation (SD) of serum total homocysteine (tHcy) level in acute myocardial infarction patients was 22.8 ± 1.30 µmol/l, which was significantly higher compared to that of control group being 15.1 ± 1.33 µmol/l (P < 0.001), indicating that a high homocysteine level may promote pathogenesis of atherosclerosis. 51 (68.9%) MI cases had hyperhomocysteinemia; of these 35 MI patients (47.3%) had mild hyperhomocysteinemia (15-30µmol/L), and 16 MI patients (21.6%) had moderate levels of hyperhomocysteinemia (30-100 µmol/L). No significant correlation between tHcy levels and MI risk factors such as hypertension, hyperlipidemia, and diabetes mellitus, was observed. The tHcy levels were significantly higher in smoker patients than in non-smokers. CONCLUSIONS: These findings confirm that in patients with acute myocardial infarction, elevated homocysteine levels are associated with development of MI independent of other risk factors. A strong association between elevated levels of serum tHcy in MI patients was observed in Kurdish population. This study concludes that Hcy is considered as a strong emerging cardiovascular risk factor for development of myocardial infarction. Moreover, the measurement of Homocysteine levels might act as a surrogate laboratory marker and as one of the effective ways to diagnose patients with myocardial infarction in hospitals.