Evaluation of a possible interaction between hyperhomocyst(E)inemia & elevated soluble vascular cell adhesion molecule-1 in predicting preeclampsia

Abstract

HYPERHOMOCYST(E)INEMIA & ELEVATED SOLUBLE VASCULAR CELL ADHESION MOLECULE-1 IN PREDICTING PREECLAMPSIA SURAB VADACHKORIA, SANCHEZ SIXTO, CHUNFANG QIU, MARTIN MUY-RIVERA, M. RENE MALINOW, MICHELLE WILLIAMS, Swedish Medical Center, Center for Perinatal Studies, Seattle, WA Dos de Mayo Hospital, Lima-1, Peru Oregon Regional Primate Research Center, Beaverton, OR OBJECTIVE: Hyperhomocystinemia (HHcy) is a risk factor of endothelial dysfunction and preeclampsia (PE). Soluble vascular cell adhesion molecule-1 (sVCAM-1), a specific marker of endothelial dysfunction, is elevated in PE. Few have assessed the joint contribution of these biomarkers in predicting PE. We assessed the extent to whichHHcy and elevated sVCAM-1 are independently and jointly associated with PE risk. STUDY DESIGN: We used information from a case-control study of 100 PE cases and 100 controls to test our study hypothesis. Maternal plasma was collected before labor onset. Total plasma homocysteine (tHcy) was measured using high-performance liquid chromatography with electrochemical detection procedures. Plasma sVCAM-1 was determined using ELISA. Using the distribution of each analyte among controls, elevated tHcy was defined as plasma tHcy > 6.6 lmol/L and elevated sVCAM-1 was defined as plasma concentrations >845 ng/mL (i.e., values above the median). Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Plasma tHcy was weakly correlated with sVCAM-1 in cases (r = 0.18, P = 0.08), but not in controls (r = 0.04, P = 0.70). Compared with women without elevated tHcy and without elevated sVCAM-1 (the referent group), those with elevated sVCAM-1 alone experienced a 4.1-fold increased risk of PE (CI 1.2-13.8). Women with elevated tHcy alone experienced a 2.2-fold increased risk of PE (OR = 2.2; CI 0.6-7.9). Women who had elevated tHcy and sVCAM-1 were 13.2 times more likely to experience PE (CI 4.1-42.2). CONCLUSION: Elevated tHcy and sVCAM-1 concentrations together are strongly associated with an increased risk of PE. Our results suggest that combining these two biomarkers may be particularly powerful in predicting the risk of PE. Future larger, prospective studies are needed to confirm these findings.