Abstract
BackgroundMetabolic syndrome (MetS) is a clinical condition potentially promoting the development of atherosclerotic disease. To date, the clinical impact of elevated serum homocysteine (Hcy) levels in MetS is still under discussion. The aim of this cross sectional study was to evaluate the relationship between MetS and hyperhomocysteinemia and the potential role of Hcy in the pathogenesis of atherosclerotic complications of MetS.MethodsWe recruited 300 outpatients with MetS. All patients underwent a medical history collection, physical examination, blood sampling and carotid ultrasound echo-color Doppler. According to Hcy levels, MetS patients were divided into two groups: “normal” (< 10.7 μmol/l; n = 140, group 1) and “high” Hcy (≥ 10.7 μmol/l; n = 160, group 2). Comparisons between groups were made by Student’s t-test or Chi-square test. The effects of potential covariates on group differences were evaluated by general linear models. The relationships between continuous variables were assessed by simple or multiple correlation and by linear regression. Multiple regression models were built to evaluate the effects of Hcy, together with other potential risk factors, on carotid atherosclerosis.ResultsPatients with high Hcy were predominantly male and slightly older than group 1 patients. Smokers and non-smokers exhibited similar Hcy levels, nor was a statistical relationship between pack-years and Hcy observed. Group 2 showed lower levels of folic acid, vitamin D, high density lipoprotein (HDL)-cholesterol and glomerular filtration rate (e-GFR) than group 1, but higher levels of C-peptide, uric acid and triglycerides. In all patients, Hcy was positively correlated with C-peptide and uric acid and negatively with folic acid and e-GFR. Intima-media thickness (IMT) and carotid stenosis degree were significantly higher in patients with high Hcy and a positive relationship between Hcy and both IMT and carotid stenosis was detected in all patients. Finally, Hcy atherogenic effects were independent of other well-known atherosclerosis risk factors.ConclusionsOur results highlight a link between MetS and hyperhomocysteinemia and a direct effect of Hcy on atherogenic process during MetS. Early correction of folic acid levels may contribute to prevent cardiovascular complications in MetS patients.
Highlights
Metabolic syndrome (MetS) is a clinical condition potentially promoting the development of atherosclerotic disease
Epidemiological and clinical data support an important link between MetS and hyperhomocysteinemia, and some studies have even suggested that increased serum levels of this amino acid may be an additional constituent of MetS [3]
Hcy and uric acid were determined by the URCA method on the Dimension Vista System (Siemens Healthcare Diagnostic Products GmbH, Marburg, Germany); vitamin B12 and folic acid were assessed by chemiluminescent immunoassay (CLIA) on the ADVIA Centaur System (Siemens); C-peptide and 25-OH vitamin D were determined by CLIA on the LIAISON analyzer (DiaSorin Inc, Stillwater, MN, USA); glycated haemoglobin (HbA1c) was assessed in human whole blood using ionexchange high-performance liquid chromatography (HPLC) on the Bio-Rad Variant II Hemoglobin A1c Program (BIO-RAD Laboratories Srl, Milan, Italy)
Summary
Metabolic syndrome (MetS) is a clinical condition potentially promoting the development of atherosclerotic disease. Prevention and treatment of the main cardiovascular risk (CVR) factors are undoubtedly priority goals to be achieved In this context, the metabolic syndrome (MetS) and increased serum homocysteine (Hcy) levels have been described as independent risk factors for cardiovascular diseases [1, 2]. The exact nature of this relationship remains unclear In all these clinical conditions the complex interaction of genetic and environmental factors, among which a sedentary lifestyle and overnutrition play a determining role, contributes to the onset and persistence of a low-grade systemic inflammation. This proinflammatory state, in turn, seems to affect the incidence of systemic complications, first of all atherosclerotic disease [4]
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