PREVALENCE OF HYPERHOMOCYSTEINAEMIA IN TH ROMBANGIITIS OBLITERANS (BUERGERS-DISEASE) - DOES HOMOCYSTEINE PLAY A PATHOGENETIC ROLE

Objective: As hyperhomocysteinaemia is known to be an important risk f actor in the early onset of arteriosclerotic occlusive disease and leg -vein thrombosis, we investigated the prevalence of hyperhomocysteinae mia in patients with thromboangiitis obliterans (TAO), a condition pre dominantly affecting peripheral arteries and veins. Patients and metho ds: Plasma homocysteine (HC), before and after administration of methi onine (0.1 g/kg) as well as serum folic acid, vitamins B-6 and B-12 we re measured in 15 patients with TAO (12 men, 3 women; mean age 33.3 ye ars: group 1), in 15 non-smelters without peripheral vascular disease (group 2) and 15 smokers without peripheral vascular disease (group 3) . At the time of the study, of those in group 1 seven were active smok ers, seven were ex-smelters and one was a non-smoker. Results: Before methionine administration four patients (27%), none of the healthy non -smokers and one smoker without vascular disease (7%) had increased HC levels (> 13.9 nmol/ml). The difference between groups 1 and 2 was st atistically significant (P < 0.05), but not that between groups 1 and 3 and between 2 and 3. 4 hours after methionine increased HC levels (g reater than or equal to 31 nmol/ml) were measured in nine patients but in none of the healthy controls. The difference between patients and the two control groups without vascular disease was clearly significan t (P = 0.0107). There was a difference in folic acid levels between th e patients and the smelters without vascular disease: in eight patient s (53%) the levels were in the lower third of normal, in six (40%) the y were in the middle and in one (7%) in the upper third. Corresponding levels in group 3 were: four (27%), three (20%) and eight (53%). Conc lusion: Hyperhomocysteinaemia occurs frequently in patients with TAO. It may play an important and nicotine-independent role in its pathogen esis.