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2003, Number 3

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Rev Med Inst Mex Seguro Soc 2003; 41 (3)

The New Cardiovascular Risk Factors: Hyperhomocysteinemia

Matadamas ZC, Pérez CE, Hernández JJ, Majluf CA

Language: Spanish
References: 96
Page: 235-249
PDF size: 275.27 Kb.


ABSTRACT

Cardiovascular disease is a main cause of morbi-morbidity worldwide, acute myocardial infarction being one of the most frequent diagnoses in developed countries. Classical cardiovascular risk factors (hyperlipidemia, smoking, diabetes mellitus, arterial hypertension) do not completely explain prevalence of coronary disease because up to 25 % of these patients have none of these risk factors. Among new cardiovascular risk factors, hyperhomocysteinemia (HHC) is an independent risk factor for atherosclerosis and thromboembolism. Homocysteine is produced through two metabolic pathways requiring specific enzymes, folate, and B12 and B6 vitamins. Homocysteine concentration is evaluated both in fasting and after methionine oral load by several methods. Normal concentration of homocysteine varies from 5 to 15 mµmol/L. HHC is the result of genetic, dietary and hormonal factors, or certain diseases or drug intake. Up to 42 % of patients with ischemic stroke, 28 % with peripheral artery disease, and 30 % with coronary disease have HHC. Furthermore, patients with atherothrombosis have higher concentrations of homocysteine than healthy individuals. Further-more, it has been suggested that 10 % of coronary patients may have HHC. Finally, there is a higher mortality rate in patients with coronary disease and HHC. Although prospective cohort studies have demonstrated a close relationship between HHC and coronary risk, this has not been reproduced in prospective studies. It may be possible that this lack of correlation is due to more strict selection criteria or comparison criteria in addition to longer follow-up periods. On the other hand, most case control and cohort prospective studies show that there is a negative and dose-dependent correlation between serum homocysteine level and daily intake of folate or B12 and B6 vitamins, and global cardiovascular risk factor. Today, several studies are being carried out to determine whether multivitamin treatment reduces cardiovascular risk. If this is confirmed, vitamin treatment may be an efficacious, non-expensive, easy-to-use, preventive treatment with a high degree of impact on public health.


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