Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors

Abstract

The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

Homocysteine metabolism as the target for predictive medical approach, disease prevention, prognosis, and treatments tailored to the person

“…Conventional risk factors of CVDs such as dyslipidemia, hypertension, smoking, or diabetes mellitus do not fully clarify all CVD events and deaths. Several studies summarized that elevated plasma Hcy denotes an independent risk factor for CVDs other than conventional risk factors and can be applied as a biomarker to predict CVD onset in individuals [77][78][79].…”

Genetic Polymorphisms in a Familial Hypercholesterolemia Population from North-Eastern Europe

“…Over time, numerous risk factors for ASCVD have been described, including a family history of CVD, age, sex, sedentary lifestyle, DM or insulin resistance, smoking, overweight or obesity, HTA, and elevated blood cholesterol levels, especially LDL [ 58 ]. A gene that has implications in the atherosclerosis process is MTHFR , two of the most studied polymorphisms being C677T and A1298C .…”

The Ketogenic Diet and Cardiovascular Diseases

“…Although some risk factors are not firmly established in the scientific evidence, they are still considered to be among the main ones. Meanwhile, others (including homocysteine) are often overlooked, whereas they may often be more meaningful indicators [9][10][11]. Taking all these factors into account, it seems that diet plays a key role.…”