Serum Total Homocysteine Levels Research Articles

Plasma Homocysteine and Lipoprotein (A) Levels in Patients with Metabolic Syndrome

A high serum total homocysteine (tHcy) level is an independent risk factor for cardiovascular disease. In this study, we examined the relationship of tHcy levels with the components of the metabolic syndrome. Fifty one patients diagnosed as metabolic syndrome (median age: 38 (25-48) years) and 50 healthy subjects (median age: 35 (26-48) years) were included in the study. Total homocysteine levels were significantly higher in metabolic syndrome group than in the control group (24.2µmol/l vs. 13.4µmol/l). Vitamin B12 levels were significantly lower in metabolic syndrome group than in the control group (214pg/ml vs. 247pg/ml). In partial correlation, tHcy concentrations were unrelated to metabolic syndrome or to the components of the metabolic syndrome, including fasting serum triglycerides, HDL-cholesterol, fasting glucose, blood pressure, or body mass index. tHcy levels were only strongly related to the vitamin B12 concentrations. The risk of cardiovascular disease is higher in patients with metabolic syndrome compared to the normal population. High tHcy levels might be evaluated in this group of patients in addition to evaluation of the parameters of metabolic syndrome.

Gene–nutrient and gene–gene interactions of controlled folate intake by Japanese women

Elevated serum total homocysteine (tHcy) levels are associated with increased risk for cardiovascular disease and dementia. The prevalence rates of homozygous mutants among Japanese women ( n=300) were 17.3%, 1.3%, 18.6%, and 5.3% for methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, reduced folate carrier (RFC-1) A80G, and methionine synthase (MS) A2756G, respectively. The tHcy value was significantly lower ( p<0.001) in young women with CC or CT of MTHFR than with TT (10.9 ± 4.7 μmol/L) ( n=250). Diversities of serum folate and tHcy in women with 23 combinations of different alleles at low folate intake converged to the highest (34.0 ± 8.6 nmol/L) and lowest (7.6 ± 1.5 μmol/L) levels, respectively, after folic acid (400 μg/day) supplementation. In the regression equation ( y= ax+ b) of serum folate ( y nmol/L) plotted against mean folate intake ( x μg/day), the values of “ a” were 0.032, 0.037, and 0.045 for individuals with CC, CT, and TT alleles, respectively, of MTHFR.

Effect of Smoking on Serum Concentrations of Total Homocysteine, Folate, Vitamin B12, and Nitric Oxide in Pregnancy: A Preliminary Study

Objective: Nitric oxide (NO) is a potent vasodilator released by endothelial cells that plays an important role in modulating maternal and fetal vascular tone in normal pregnancy. Lower plasma levels of vitamins may result in hyperhomocysteinemia, a known risk factor in pregnancy. The aim of this study was to investigate whether there are alterations in the serum levels of total homocysteine (tHcy), folate, vitamin B₁₂, and total nitrite, as an index of NO, in smoking as compared with age-matched nonsmoking pregnant women. Methods: Thirty-three women (19 smoking and 14 nonsmoking) between 16 and 22 weeks of their gestation were included in this study. The serum tHcy levels were analyzed by using an enzyme-linked immunosorbent assay kit. Vitamin B₁₂ and folate values were measured by means of DPC kits. Total nitrite was measured by Griess reaction as an index of endogenous NO production. Results: The serum tHcy concentrations were significantly increased in smoking as compared with nonsmoking pregnant women (p < 0.001). The folate and vitamin B₁₂ concentrations were lower in smoking than in nonsmoking pregnant women, but only the differences in folate concentrations were statistically significant (p < 0.001). The tHcy concentrations showed a significant negative correlation with folate in the smoking pregnant women. The serum total nitrite concentrations were lower in smoking than in nonsmoking pregnant women (p < 0.05). In addition, the serum nitrite levels in smoking pregnant women had significant negative correlations with tHcy and positive correlations with folate and vitamin B₁₂ levels. Conclusions: In the light of our findings, we propose that smoking might enhance the vasoconstrictor capacity in pregnant women by increased tHcy concentrations and by a simultaneous decrease in the production of NO which is a vasodilator compound.

Folate Intake, Serum Folate, Serum Total Homocysteine Levels and Methylenetetrahydrofolate Reductase C677T Polymorphism in Young Japanese Women

Various factors influence folate status and requirements. To investigate the folate status in young Japanese women (n=340, 20-22 y), I determined the serum folate and total homocysteine (tHcy), and examined the influence of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on folate status in a subgroup of 252 of the women. I calculated folate consumption based on records of food intake weighed over 3 d using the standard Tables of Food Composition in Japan (5th revised edition) and the US Food Composition Table based on the USDA nutrient database excluding fortification. Serum folate and total homocysteine (tHcy) levels were determined by chemiluminescent-competitive protein binding assay and HPLC, respectively. The mean intake of folate was 323+/-133 and 196+/-71 microg/d, and 86.5% and 42.1% of the participants consumed more than the RDA of 200 microg of folate, according to the Japanese and US tables, respectively. The main sources of dietary folate were vegetables, green tea and bread. Serum folate levels were significantly correlated with folate intake (r=0.249, p<0.001). Serum tHcy levels were above 15 micromol/L in four participants. I found significant negative correlations between serum tHcy and folate intake (r=-0.175, p<0.05), and between serum tHcy and serum folate (r=-0.297, p<0.0001). The frequencies of the CC, CT and TT genotypes of the MTHFR gene were 32.9, 51.6 and 15.5%, respectively. Among individuals with the TT genotype, serum folate and tHcy levels were lower and higher, respectively, than in those with the other genotypes, regardless of folate intake above RDA. These data suggest that the current RDA of folate estimated based on foreign data might not be sufficient for Japanese and that this value might require reassessment.

Homocysteine in Renal Transplant Recipients: Association with Transplant Duration and Renal Function

Background: Hyperhomocystinemia is an established risk factor for cardiovascular events and has been identified as an important cause of morbidity and mortality in renal transplant recipients. This investigation was aimed to determine the effect of age and transplant duration on serum total homocysteine (tHcy) levels in renal transplant recipients. Methods: We analyzed serum levels of tHcy, albumin, alkaline phosphatase, alanine transferase, bilirubin, calcium, corrected calcium, cholesterol, creatinine, folate, phosphate, potassium, sodium, triglycerides, urea and vitamin B12 in 88 transplant patients (ages, 14–67 years; transplant duration, 1–252 months) and 60 control subjects. Results: Our results showed significant hyperhomocystinemia in transplant patients (19.92 ± 0.72) as compared to controls (9.28 ± 0.25), while male subjects in both groups had significantly higher tHcy than females. There was no correlation between patients' age and serum tHcy, whereas the time after transplantation was significantly correlated with tHcy (r = 0.318, P < 0.01). A significant correlation was observed between tHcy and serum urea, creatinine, vitamin B12 and potassium in renal transplant patients. Conclusion: This study clearly demonstrated significant hyperhomocystinemia and renal impairment in transplant recipients. A time‐course increase in serum tHcy during posttransplant duration warrants long‐term monitoring of patients for effective clinical management.

Reported symptoms and clinical findings in relation to serum cobalamin, folate, methylmalonic acid and total homocysteine among elderly Swedes: a population-based study.

The early stages of tissue B12 or folate deficiency often cause diagnostic problems. In this report, the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy), and their relationships with clinical findings and reported symptoms in a representative random population sample are presented. Cohort study. A general central Swedish population 70 years or older. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, of whom 161 had no interfering diseases or medication. Blood specimens for serum cobalamin, folate, MMA and tHcy analyses were drawn. Presence of anaemic, gastrointestinal, neurological and psychiatric symptoms, obtained by questionnaire, and vibration sense measurement and findings at a physical and Mini Mental State Examination. Among a large number of symptoms and clinical findings that traditionally have been linked to vitamin B12 or folate tissue deficiency, only changes in the tongue mucosa and mouth angle stomatitis turned out to be significantly associated with abnormal serum tHcy and serum folate levels. There were no relationships to serum cobalamin and serum MMA. Changes in the oral mucosa were the only signs and symptoms found in this study, indicating that these may be the very early markers of metabolic defects. The traditional symptoms of vitamin deficiency may appear later in the course.

Effect of hormone replacement therapy and tibolone on serum total homocysteine levels in postmenopausal women

Objective: To assess the effect of continuous combined hormone replacement therapy (HRT) or tibolone on serum total homocysteine (tHcy) levels in postmenopausal women. Study design: Ninety-five postmenopausal women aged 41–68 years were included in the study. Seventy-three women with climacteric complaints, osteopenia or osteoporosis received either conjugated equine estrogens 0.625 mg combined with medroxyprogesterone acetate 5 mg (CEE/MPA, n=31) or tibolone 2.5 mg ( n=42). Twenty-two healthy women, matched for chronological and menopausal age, served as controls. Serum tHcy levels were assessed at baseline, 6, 12 and 18 months. Results: No difference was recorded between groups regarding demographic characteristics or mean baseline serum tHcy. Serum tHcy levels decreased significantly in the CEE/MPA compared to baseline (change at 18 months: −3.9%, P<0.05). The magnitude of the decrease was higher in the subgroup of women with baseline tHcy levels above the median (change at 18 months: −15.0%, P<0.01). No change in tHcy levels was detected in the tibolone group throughout the study period, either in the whole group (change at 18 months: 1.9%, NS) or in the subgroup with baseline tHcy levels above the median (change at 18 months: −3.23%, NS). Conclusion: Continuous CEE/MPA reduces tHcy especially in women with high pretreatment tHcy levels. Tibolone has no effect on serum tHcy levels at least during the first 18 months of therapy. Larger studies with longer follow-up are required to confirm these results.

Cobalamin deficiency with and without neurologic abnormalities: differences in homocysteine and methionine metabolism: Presented in preliminary form at the 44th Annual Meeting of the American Society of Hematology, Philadelphia, PA, December 7, 2002.

AbstractThe unknown biochemical basis for neurologic dysfunction in cobalamin deficiency and the frequent divergence between neurologic and hematologic manifestations led us to study homocysteine metabolism in 22 patients with pernicious anemia. Serum levels of total homocysteine (tHcy), methionine,S-adenosylmethionine (AdoMet), cysteine, cysteinylglycine (cys-gly), and glutathione (GSH) were measured. Only levels of tHcy and cysteine were increased and only GSH was decreased in cobalamin deficiency as a whole, compared with 17 control subjects. AdoMet correlated only with methionine levels (P= .015) and cysteine only with cys-gly (P= .007) in healthy subjects, but in cobalamin-deficient patients AdoMet correlated instead with cysteine, cys-gly, and folate levels only (P= .008,P= .03, andP= .03, respectively). Significant differences appeared in clinically subgrouped cobalamin-deficient patients. The 11 patients with neurologic defects had higher mean levels of folate (27.9 versus 15.4 nM), AdoMet (117.2 versus 78.6 nM), cysteine (462 versus 325 μM), and cys-gly (85.0 versus 54.7 μM) than the 11 neurologically unaffected patients. Cobalamin therapy restored all metabolic changes to normal. The results indicate that changes in several metabolic pathways differ in patients with and without neurologic dysfunction. Cysteine levels were the most significant predictors of neurologic dysfunction, but it is unclear if they are direct or indirect indicators of neurotoxicity. The higher AdoMet levels in neurologically affected patients may result from inhibition of glycineN-methyltransferase by those patients’ higher folate levels. The origin of the folate differences is unclear and possibly varied. Low AdoMet and GSH levels were independent predictors of anemia.

Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients

Background: Hyperhomocysteinemia may constitute an independent risk factor for cardiovascular disease and may promote atherothrombosis. Psoriasis is one of the diseases associated with increased atherothrombosis. The aim of the present study was to examine serum total homocysteine (tHcy) level and its relationships with atherothrombotic markers. Methods: The study group included 30 patients with psoriasis (17 females and 13 males) with a mean age of 34.2 (age range: 27–40) and 30 sex and age matched healthy volunteers (15 females and 15 males) with a mean age of 36.7 (age range: 26–48). The concentrations of lipids, lipoproteins, acute phase reactants, tHcy and atherothrombotic markers [fibronectin, soluble vascular adhesion molecules-1 (sVCAM-1), soluble intercellular adhesion molecules-1 (sICAM-1), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), autoantibodies against oxidized LDL (AuAb-oxLDL)] were determined. Results: The mean levels of serum tHcy, fibrinogen, fibronectin, sICAM, PAI-1 and AuAb-oxLDL were increased in patients whereas tPA, vitamin B 12 and folate levels were decreased significantly. Increased levels of sVCAM were not statistically significant. tHcy levels were negatively correlated with vitamin B 12 ( r=−0.40, P=0.027) and positively correlated with PAI-1 and AuAb-oxLDL levels ( r=0.46, P=0.011; r=0.39, P=0.035, respectively). Conclusions: It was concluded that the increased homocysteine concentration and altered endothelial cell-mediated proteins associated with increased lipids and LDL oxidation may play an important role for the development of atherothrombotic complications with psoriasis.

Serum levels of total homocysteine, homocysteine metabolites and of advanced glycation end-products (AGEs) in patients after renal transplantation.

Hyperhomocysteinemia has been described as an independent risk factor for cardiovascular diseases (CVD) influencing patient outcome. Advanced glycation end-products (AGEs) are involved in the pathogenesis of vascular damage in uremia. This study was undertaken to assess whether high serum levels of total homocysteine (tHcy) with its metabolites methylmalonic acid (MMA), methylcitric acid (MCA) and cystathionine (CYSTA) as well as elevated serum concentrations of the AGEs pentosidine and Nepsilon-carboxymethyllysine (CML) are independent risk factors for CVD, left ventricular hypertrophy (LVH) or hypertension as well as kidney dysfunction in renal transplant recipients (RTR). Serum levels of tHCy, MMA, MCA and CYSTA were measured by a gas chromatographic-mass spectrometric assay, pentosidine by HPLC and CML using an ELISA assay. All measured parameters were significantly higher in RTRs than in healthy subjects (p < 0.0001). The levels of pentosidine and CML as well as of tHcy and its metabolites correlated significantly with each other, but not with those ofMMA and CYSTA. Significant correlations were also found between pentosidine and tHcy, MMA or MCA as well as between CML, MMA and MCA, respectively. Acute or chronic rejection did not influence these values. No significant differences were observed between patients with or without CVD or with hypertension. In RTRs with LVH, only the tHcy levels were significantly higher than in those RTRs without LVH (p = 0.006). Logistic regression analysis revealed an independent influence of tHcy on the presence of LVH. These results may indicate an association between high tHcy values and LVH. Further investigation is needed to determine whether a reduction of tHcy and Hcy metabolites and/or AGE serum concentrations would significantly improve patient outcome after undergoing renal transplantation.

2P-0370 Effect of serum total homocysteine levels on the extent of coronary artery disease

2P-0370 Effect of serum total homocysteine levels on the extent of coronary artery disease

Serum homocysteine, creatinine, and glucose as predictors of the severity and extent of coronary artery disease in asymptomatic members of high-risk families.

There has been no previous study to determine the severity and extent of coronary artery disease (CAD) in subjects with no diagnosis or symptoms of CAD at the time of the angiography. Fifty-three subjects, who were siblings of patients with early onset CAD, underwent coronary angiography. Indices to describe per-patient characteristics of CAD were calculated, based on computer-aided quantitative coronary angiography. Clinical and laboratory characteristics were correlated to the angiographic parameters. Serum total homocysteine (rho = 0.29, P < 0.05) and creatinine (rho = 0.47, P = 0.001) levels were related to the global atheroma burden index. The median of the atheroma burden index was two times higher in the top homocysteine quartile compared to the lowest quartile. The overall atheroma burden index correlated significantly with the fasting blood glucose level in all subjects. Diabetes, especially when albuminuria was present, was a powerful risk factor. In a multivariate analysis, only age and sex were independent predictors of atheroma burden. Serum homocysteine and creatinine concentrations, and diabetes with albuminuria were found to be markers of the severity and extent of CAD in subjects of high-risk families without symptoms of CAD.

Unexpected Inverse Relationship of Insulin Resistance and Serum Homocysteine in Healthy Subjects

Mild hyperhomocysteinemia has been established as a new independent risk factor for atherosclerosis and thrombosis. The metabolic syndrome of insulin resistance is associated with a high risk of coronary heart disease. Our objective was to determine if any relationship exists between the metabolic syndrome of insulin resistance in non-diabetic subjects and total serum homocysteine levels. Sixty-six healthy volunteers (33 males and 33 females) were selected from the population of Pilsen. Insulin resistance was measured by the Insulin Suppression Test using Octreotide. Steady-state plasma glucose concentrations at the end of the test period provided a quantitative measure of insulin resistance. Serum homocysteine level was estimated by high-pressure liquid chromatography. Serum folate and vitamin B12 were estimated using commercial kits on an Abbott IMx analyzer. All other laboratory tests were performed by standard methods in a routine biochemical laboratory. Subjects with the highest tertile of steady-state plasma glucose showed a significantly higher body mass index, blood pressure, fasting plasma triglyceride levels, plasminogen activator inhibitor-1 and lower HDL-cholesterol, i.e. an insulin resistance pattern. These subjects had significantly lower serum homocysteine levels compared with non-insulin resistant subjects. The negative association of insulin resistance and serum homocysteine was unexpected. The contribution of plasma folate levels to serum homocysteine levels and serum creatinine was significantly negative and positive, respectively.

Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke.

The mechanisms of ischemic stroke in young adults are poorly understood. During the last years, several studies suggested a role for genetic factors predisposing to thrombophilia and for moderate hyperhomocysteinemia in this setting. We evaluated in 132 consecutive patients (66 males, 66 females; mean+/-SD age, 38.4+/-11.7 years; mean+/-SD age at first event, 34.8+/-10.9 years; range, 6 months to 50 years) referred to our center between January 1997 and December 1999 for a history of young adult ischemic stroke (age at first event, <51 years) the prevalence of factor V (FV) Leiden, prothrombin (FII) G20210A, and C677T and 5,10-methylenetetrahydrofolate reductase (MTHFR) gene mutations and fasting serum total homocysteine levels. Two hundred sixty-two apparently healthy subjects (117 males, 145 females; mean+/-SD age, 36+/-13.2 years) served as controls. Total homocysteine levels differed significantly (P=0.004, t test) between patients and controls: 13.03+/-18.61 versus 10.75+/-6.24 micromol/L (mean+/-SD), respectively. In contrast, homozygosity for the TT mutation of the MTHFR gene was 30 of 132 (22.7%) in patients and 45 of 262 (17.2%) in controls; this difference was not statistically significant (P>0.05, chi(2) test). However, when we stratified the whole population according to genotype, fasting serum homocysteine levels were significantly higher in TT patients than in TT controls (25.3+/-36.8 versus 15+/-11.6 micromol/L; P=0.02, t test). Mutations of FV Leiden and of FII G20210A gene are currently reported to be associated with a tendency toward ischemic stroke. Their frequencies were not statistically significantly different between patients and controls in this setting: 7 of 132 (5.3%) versus 17 of 262 (6.5%) for FV Leiden and 10 of 132 (7.6%) versus 16 of 262 (6.1%) for FII G20210A, respectively (all P>0.05, chi(2) test). In the present cohort of patients, moderate hyperhomocysteinemia is the only variable that helps to identify young adults with a history of ischemic stroke.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women. Cross-sectional study. Patan Hospital, Kathmandu, Nepal. A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis. Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate. Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women. The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Is blood homocysteine elevated in migraine?

To determine total serum homocysteine levels in a large group of patients with migraine with and without aura. Hypercoagulable state is a known risk factor for stroke in the young. The existence of a hypercoagulable state has been postulated in migraine and homocysteinemia with young-onset stroke. To the best of our knowledge, blood homocysteine has not been studied in a significant number of patients with various forms of migraine. Total serum homocysteine was measured with high-performance liquid chromatography in 78 patients with migraine and in 126 age- and sex-matched healthy volunteers. Seventy-eight patients aged 18 to 65 years were studied: 22 with migraine with aura and 56 with migraine without aura. Only 1 man had significantly elevated blood homocysteine (38.6 micromol/L), while another had a borderline elevation (15.8 micromol/L) (reference value for both sexes in our laboratory is 4 to 14 micromol/L). Both patients suffered from migraine without aura. Blood homocysteine is not elevated in migraine.

Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects

Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8±7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm 3). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6±2.2 and 5.3±3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9±3.7 μmol/l pre-treatment and 14.4±5.0 μmol/l during treatment with TMP-SMX, a non-significant increase of 0.5 μmol/l (95% CI: −0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1±6.5 nmol/l versus 13.3±5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.

Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes--a population-based study.

The possibilities of detecting tissue cobalamin and folate deficiency are under debate. In this report the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) and their interrelations in a representative random population sample are presented. Cohort study. A general mid-Swedish population. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, out of whom 224 had no interfering diseases. Serum cobalamin, folate, MMA and tHcy. The serum levels of cobalamin, folate, MMA and tHcy were all correlated to cobalamin and folic acid treatment. They were also correlated to the intake of multivitamin preparations. In addition, serum cobalamin was higher in untreated women than in men but not correlated to age. Serum folate was correlated neither to sex nor age. Serum tHcy and MMA were both directly correlated to age but MMA not to sex. MMA was inversely correlated to serum cobalamin but not to serum folate, whereas serum tHcy was inversely correlated to serum cobalamin, folate and creatinine. Neither serum cobalamin, folate, MMA nor tHcy had any significant correlation to haemoglobin, erythrocyte volume fraction (EVF) or mean red cell volume. Half of the study population had abnormal MMA or tHcy levels, suggesting a latent or overt tissue deficiency of cobalamin or folate. A substantial proportion of the elderly general population had signs of low tissue levels of cobalamin or folate. Amongst those who took multivitamin preparations this proportion was much lower.

Correlation between total homocysteine, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the serum of patients with myocardial infarction

Objectives: Determine the Low-density lipoprotein cholesterol (LDL-C), High-density lipoprotein cholesterol (HDL-C) and serum total homocysteine in myocardial infarction patients and control subjects. Design and methods: The study group consisted of 126 patients 67 male, and 59 females, aged 29–73 (mean 48.65 ± 3.81) years. The entry criteria for the patient group was typical or atypical chest pain, unequivocal changes in the electrocardiogram. The control group consisted of 135 normal volunteers, 71 male and 64 females, age 21–63 (mean 42.73 ± 5.79) years. Measurement of serum total homocysteine was performed using gas chromatography. Measurement of Low-density lipoprotein cholesterol, and High-density lipoprotein cholesterol were performed using spectrophotometer. Results: Patients with myocardial infarction were found to have higher serum total homocysteine levels than controls, ( P < 0.05). Serum total homocysteine levels were significantly correlated with low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. There was a negative correlation between total homocysteine and HDL-C levels ( P < 0.05, r = −0.93). There was a positive correlation between total homocysteine and LDL-C levels ( P < 0.05, r = 0.98). Conclusions: The above mentioned findings suggest the potential usefulness of LDL-C, HDL-C and serum total homocysteine as prognostic markers in myocardial infarction patients. These findings should influence future studies on the etiology and pathogenesis of myocardial infarction.

Homocysteine/coronary atherosclerosis and cardiac transplantation:a case control study

Accelerated coronary atherosclerosis (CAD)is a rate limiting process in the long term success of cardiac trnasplantation (CTx). Hyperhomocysteinemia (HC) is a major risk factor for vascular disease including CAD. We have hypothesized that HC is a major contributing risk factor in transplant coronary artery disease (TxCAD). We measured fasting serum total homocysteine and creatinine levels in cardiac transplant patients (n=24) and compared them with age and sex matched patients (n=19) with ischemic cardiomyopathy (controls, C). Serum homocysteine levels were found to be significantly elevated (19.27±7.05 umol/l)in cardiac transplant patients when compared with controls. (12.56±5.42 umol/l, p<0.001). Serum homocysteine levels did not correlate with serum creatinine (range 0.8-8.2 mg/dl) in cardiac transplant patients (r=0.065) while a strong correlation was found to exist between serum creatinine and homocysteine levels in the control group (r=0.83). There was no correlation between serum homocysteine levels and duration of cardiac transplantation(range 0.5-15 years). There was a strong correlation between homocysteine and CAD in the cardiac transplant patients and no correlation in the controls.