Hyperhomocysteinemia (HH) and metabolic syndrome (MS) are associated with increased cardiovascular risk. However, whether there is a link between MS or its components and homocysteine levels in a population without cardiovascular disease is not well established. We conducted a case-control study in 61 MS patients (41 males, 20 females, aged 51 ± 11 years) and in 98 controls without MS (59 males, 39 females, aged 50 ± 10 years) to ascertain the association between MS and HH, and with inflammatory markers. MS was classified according to the updated ATPIII criteria [17]. No differences in homocysteine levels were observed when comparing MS patients and controls (12.0 ± 3.18 M vs. 11.9 ± 3.5 M, p = 0.829). No association was found between HH (homocysteine >15 M) and MS, its components (abdominal obesity (p = 0.635), hypertension (0.229), low-HDL cholesterol (p = 0.491), glucose >100 mg/dL (0.485), hypertriglyceridemia (p = 0.490)) or the number of MS components (p = 272). When considering glucose >110 mg/dL (NCEP-ATPIII criteria, 2001) instead of glucose intolerancen >100 mg/dl (updated ATPIII criteria, Grundy, 2005), a borderline association with HH was observed (p = 0.054) of statistical significance (p = 0.008) when glucose >126 mg/dL was considered. In a multivariate regression model, creatinine, folic acid and vitamin B12 were the only independent predictors of homocysteine levels (p < 0.05).Although MS correlated with inflammatory parameters (fibrinogen, hs-RCP, plasma viscosity and leukocyte count, p < 0.001), no association was found between HH and the above-mentioned parameters (p > 0.05).Our results do not indicate a link between SM or its individual components with HH, and diabetes was the only relevant contribution. Cardiovascular disease risk due to MS and HH seems to share no common mechanisms.

To the Editor. The association between high red blood cell distribution width (RDW) and cardiovascular events and heart failure has been reported [4,7]. The link between elevated RDW and cardiovascular disease (CVD) risk may be due to an underlying chronic inflammation mediated by proinflammatory cytokines that could influence erythrocyte maturation [4]. The metabolic syndrome (MS) is a chronic inflammatory disorder that increases the risk of cardiovascular events and death [5]. A recent study [6] has found an association between RDW and MS with doubtful results, as the association is weak, lower than that for cardiovascular events and iron, vitamin B 12 and folic acid, which may influence RDW have not been determined either.We have performed a case-control study evaluating the association between RDW and MS as well as with the several components of MS, i.e., abdominal obesity, low HDL cholesterol, hypertension, hypertriglyceridemia and glucose intolerance. The study was performed in accordance with the ethical guidelines for Clinical Hemorheology and Microcirculation [2].We included 61 patients with MS classified according to the NCEP ATPIII criteria modified by Grundy et al. [5] and 94 controls without MS. We determined RDW along with iron, vitamin B 12 , folic acid, erythrocyte indices, glucose, lipids, fibrinogen, hs-CRP and neutrophil count.A cut-off point of 14% corresponding to the control group mean plus one SD was considered for high RDW; 358 mg/dL for high fibrinogen and 28.61 pg for low MCH.No differences in RDW nor in vitamin B 12 , folic acid, iron, or erythrocyte indices were observed (p > 0.05). Hematocrit was statistically higher in patients than in controls (p = 0.022) as were hs-CRP, fibrinogen and neutrophils count (p < 0.001) (Table 1).