Research - Hoogeveen

High Homocysteine is associated with an increased risk of cardiovascular disease, especially in non-insulin-dependent diabetes mellitus

Background
A high homocysteine level is a risk factor for cardiovascular disease, independent of classic risk factors. However, it is not known whether the strength of the association between elevated homocysteine and cardiovascular disease is similar for peripheral arterial, coronary artery, and cerebrovascular disease.

A recent study found that the risk of cardiovascular disease was especially high in patients who had elevated homocysteine and also smoked or had hypertension. This indicates that there may be an interaction between these risk factors.

There is also evidence that elevated homocysteine is common in the elderly population Ð largely attributable to a low intake of the folate, B12 and B6.

Why did the researchers do this particular study?
- To compare the risk estimates between elevated homocysteine and peripheral arterial, coronary artery and cerebrovascular disease.
- To examine the combined effect of elevated homocysteine and diabetes mellitus on cardiovascular disease risk.
- To estimate the benefit of increasing the intake of folate in an effort to lower homocysteine levels and decrease cardiovascular risk.

Who was studied?
A random sample of 631, 50-75-year-old, general white population from the municipal population registry office of the town of Hoorn

What did the researchers find?
- The magnitude of the association between Hyperhomocysteinemia and cardiovascular disease was similar with respect to peripheral, coronary, and cerebral arterial disease.
- Hyperhomocysteinemia appeared to be a stronger risk factor for cardiovascular disease in subjects with NIDDM than in subjects with normal or impaired glucose tolerance.
- The prevalence of Hyperhomocysteinemia was high in this patient group.

What are the implications of this study?
A potential reduction of approximately 10% of the total burden of cardiovascular disease could be achieved by a distribution shift of 5 micromoles per liter in total homocysteine level.

Reference: Hoogeveen EK, et al. Hyperhomocysteinemia is associated with an Increased Risk of Cardiovascular Disease, Especially in Non-Insulin-Dependent Diabetes Mellitus. Arterioscler Thromb Vasc Biol. 1998; 18: 133-138.

HOMOCYSTEINE FACT:

Lowering homocysteine concentrations by 3 umol/l from current levels (achievable by increasing folic acid intake) would reduce the risk of ischaemic heart disease by 16%, deep vein thrombosis by 25%, and stroke by 24%.