Hyperhomocystinemia.

Abstract

In the article by Pianka et al (Ophthalmology 2000;107:1588–92) regarding the prevalence of hyperhomocystinemia in patients with vascular events of the optic nerve and retina, elevated homocysteine seems to be a risk factor for vascular events in general. The prevalence of hyperhomocystinemia in visual vascular events would be of interest, especially because this would serve as a separate risk factor beyond that conferred by traditional vascular risks such as hypertension, diabetes, cardiovascular disease, hypercholesterolemia, and tobacco use. The data presented by Pianka et al was of interest in this regard, however, without control data on the prevalence of traditional vascular risk factors in the control group, the results are difficult to interpret. The crucial question regarding hyperhomocystinemia concerns the value of homocysteine levels as a separate, stand-alone risk factor. Perhaps elevated homocysteine levels are merely a marker of vascular disease related to the traditional vascular risk factors (as well as other, yet-to-be defined risk factors). A properly performed case-controlled study would help answer this question, and the design would need to control for vascular risk factors. Pianka et al could contribute to this question by comparing their patient cohort with a truly matched control group. In the article by Pianka et al (Ophthalmology 2000;107:1588–92) regarding the prevalence of hyperhomocystinemia in patients with vascular events of the optic nerve and retina, elevated homocysteine seems to be a risk factor for vascular events in general. The prevalence of hyperhomocystinemia in visual vascular events would be of interest, especially because this would serve as a separate risk factor beyond that conferred by traditional vascular risks such as hypertension, diabetes, cardiovascular disease, hypercholesterolemia, and tobacco use. The data presented by Pianka et al was of interest in this regard, however, without control data on the prevalence of traditional vascular risk factors in the control group, the results are difficult to interpret. The crucial question regarding hyperhomocystinemia concerns the value of homocysteine levels as a separate, stand-alone risk factor. Perhaps elevated homocysteine levels are merely a marker of vascular disease related to the traditional vascular risk factors (as well as other, yet-to-be defined risk factors). A properly performed case-controlled study would help answer this question, and the design would need to control for vascular risk factors. Pianka et al could contribute to this question by comparing their patient cohort with a truly matched control group. Author replyOphthalmologyVol. 108Issue 8Preview Full-Text PDF