Homocysteine Status and Polymorphisms of Methylenetetrahydrofolate Reductase Are Not Associated With Restenosis After Stenting in Coronary Arteries

Abstract

Objective-We investigated the influence of elevated homocysteine plasma levels and 2 polymorphisms, 677C/T and 1298A/C, of the methylenetetrahydrofolate reductase (MTHFR) gene on the risk of restenosis after stenting in patients with symptomatic coronary artery disease. Methods and Results-Homocysteine levels and MTHFR genotypes were determined in 800 consecutive patients treated with coronary artery stenting. Angiographic restenosis (Ն50% diameter stenosis at 6-month follow-up) was present in 25.8% of the patients with low homocysteine levels (at or below the median of 11.6 mol/L; nϭ400) and 24.1% of the patients with high homocysteine levels (Ͼ11.6 mol/L; nϭ400; Pϭ0.62). Rates of angiographic restenosis were 26.0%, 23.5%, and 26.9% in carriers of the 677CC, 677CT, and 677TT genotypes (Pϭ0.75), respectively, and 24.4%, 25.9%, and 24.0% in patients with the 1298AA, 1298AC, and 1298CC genotypes (Pϭ0.90), respectively. The need for restenosis-driven reintervention (clinical restenosis) was 18.8% in subjects with low homocysteine concentrations and 19.0% in subjects with high homocysteine concentrations during the first year after the intervention (Pϭ0.93). Rates of clinical restenosis were 19.5%, 17.1%, and 23.3% in carriers of the 677CC, 677CT, and 677TT genotypes (Pϭ0.37), respectively, and 17.6%, 18.6%, and 24.7% in patients with the 1298AA, 1298AC, and 1298CC genotypes (Pϭ0.27), respectively. Conclusions-Elevated

Homocysteine and methylenetetrahydrofolate reductase C677T and A1298C polymorphisms in Tunisian patients with severe coronary artery disease

“…The contribution of MTHFR polymorphisms and changes in plasma homocysteine levels to CAD pathogenesis were reported with inconsistent results [10,11,14,15]. Our results demonstrated select associations between MTHFR C677T, but not A1298C, alleles and genotypes, with CAD, highlighted by the increased prevalence of the 677T allele and 677T-containing genotypes (677C/T and 677T/T) among CAD patients compared to controls.…”

“…MTHFR 677T/T is associated with significantly elevated homocysteine levels, and thus precipitates enhanced CAD risk [10][11][12], particularly in the presence of low folate [13]. Others suggested no association [14,15], or association only with folate deficiency whereby low-normal serum folate may prevent the onset or attenuate CAD development [13]. In contrast to the C677T polymorphism, the A1298C polymorphism is not associated with CAD [11,16]; although one report claimed that A1298C heterozygosity, acting by elevating homocysteine, was associated with CAD [17].…”

Present status of outcome prediction of invasive coronary treatment by using genetic markers

“…There was also no relation of this genetic alteration with the risks of in-stent restenosis [Koch et al, 2003a] and graft atherosclerosis in patients with CABGs [Iwama et al, 2001], respectively. In contrast to these negative findings, a couple of small studies Botto et al, 2004] reported that the sequence variation influenced the size of the vessel area affected by intimal hyperplasia ] and the outcome after PTCA or CABG surgery [Botto et al, 2004], respectively.…”

A hiperhomocisteinemia como fator de risco cardiovascular: perspectivas atuais

“…Concluíram que a distribuição dessas duas variantes da MTHFR era semelhante e que nenhuma delas se correlacionava com coronariopatia na população árabe 40 . Nesse mesmo ano, Koch et al 41 investigaram a influência da HHcy e dos dois polimorfismos da MTHFR no risco de re-estenose em seis meses após angioplastia com "stent" em 800 pacientes coronariopatas sintomáticos. A taxa de re-estenose foi semelhante entre aqueles com HHcy e aqueles com homocisteinemia normal.…”