Hyperhomocysteinemia and inflammatory biomarkers are associated with higher clinical SYNTAX score in patients with stable coronary artery disease

Abstract

Background/Aim. Previous studies have confirmed a positive correlation between homocysteine levels and a greater risk for acute coronary syndrome and stroke, but there are no available data to support an association between homocysteine and inflammatory markers and the severity of coronary artery disease according to Clinical SYNTAX score in patients with stable angina. The aim was to determine the association between homocysteine and inflammatory biomarkers levels: interleukin 6, high sensitive C reactive proteine, fibrinogen, erythrocyte sedimentation rate and severity of coronary artery disease according to Clinical SYNTAX score. Methods. Eighty-two patients with stable angina pectoris (average age 65 ± 8 years, 28.9% females) underwent coronary angiography and were divided into three groups according to Clinical SYNTAX score: the group I < 22 (39 patients), the group II 23-32 (16 patients), the group III > 33 (27 patients). The severity and complexity of coronary artery disease were calculated by Clinical SYNTAX score, multiplying the SYNTAX score with the modified ACEF score, based on the patients' left ventricular ejection fraction, age and creatinine clearance (derived with Cockcroft-Gault equation). Results. Homocysteine levels were significantly higher in patients with high Clinical SYNTAX (the group I: median (IQR): 10.20 (3.97), the group II: 10.45 (5.77), the group III: 14.70 (7.50), p = 0.005). Patients in group III had significantly higher homocysteine levels compared to group I (p = 0.001). We also found positive association between inflammatory biomarkers (interleukin 6, high sensitive C reactive proteine, fibrinogen, erythrocyte sedimentation rate) and severity of coronary artery disease according to Clinical SYNTAX score (p = 0.017, 0.001, 0.032, 0.049 respectively). We detected significantly lower plasma levels of Vitamin B12 in group III and group II in comparison with group I (the group I: median (IQR): 238 (160), the group II: 171 (160), the group III: 172 (102), p = 0.022), which indicate its important role in homocysteine metabolism. Conclusion. Elevated plasma levels of homocysteine, interleukin 6, high sensitive C reactive proteine, fibrinogen, erythrocyte sedimentation rate were detected in patients with high Clinical SYNTAX score (> 33). Our results showed that hyperhomocysteinemia and some inflammatory biomarkers can predict more severe and extent coronary artery disease in stable angina patients. hiperhomocisteinemija i pojedini inflamacijski biomarkeri mogu ukazati na prisustvo ozbiljnije i ekstenzivnije koronarne arterijske bolesti kod pacijenata sa stabilnom anginom pektoris. Ključne reči: koronarna arterijska bolest, homocistein, inflamacijski biomarkeri, klinički SINTAKS skor.

Homocysteine, Vitamins B6 and Folic Acid in Experimental Models of Myocardial Infarction and Heart Failure—How Strong Is That Link?

“…Several studies have shown that folic acid and vitamin B12 supplementation can lower Hcy concentration [70], and supplementation with folic acid can improve damaged vascular endothelial function in CAD [71]. HHcy is also positively correlated with the severity of CAD [72]. Another study showed a positive correlation between Hcy level and CAD, as well as significant negative correlation between Hcy levels and folic acid concentration in all CAD categories [66].…”