Homocyst(e)ine and atherosclerosis in patients on chronic hemodialysis

Hyperhomocyst(e)inemia is an established risk factor for atherosclerosis. W e performed this study to identify the correlating variables and risk facto rs for atherosclerosis, as measured by the atherosclerotic score (AS), and to determine the relative risk for cardiovascular disease in relation to pl asma homocyst(e)ine levels in patients on chronic hemodialysis. We evaluate d and measured 61 patients on chronic hemodialysis for clinical and biochem ical parameters including atherosclerotic score (AS) and plasma homocyst(e) ine. We divided patients into high and low groups, first, by the mean AS, a nd second, by the median value of plasma total homocyst(e)ine levels. Then we compared the variables between the two groups. Out of the 61 patients, t he median plasma total homocyst(e)ine level was 24.4 mu mol/L (mean+/-SD, 2 7.7+/-17.4; range, 9.8-127.4 mu mol/L), and the median AS was 5 (mean+/-SD, 6.2+/-2.8; range, 3-13) out of a possible 20 points. AS was significantly correlated with plasma total homocyst(e)ine levels (r=0.37) and age (r=0.67 ). Through multivariate analysis, plasma total homocyst(e)ine level and age were determined as significant risk factors for the high-AS group (p<0.05) . However, plasma total homocyst(e)ine level did not correlate with age (p> 0.05). Eighteen of the 61 patients, presented with cardiovascular disease u ntil the present study, had an AS>6. Cardiovascular disease was found more often in the high-homocyst(e)ine group (>24.4 mu mol/L) than in the low-hom ocyst(e)ine group (odds ratio, 9.3; 95% confidence interval, 2.3-37.4). Reg ardless of age, hyperhomocyst(e)inemia (especially homocyst(e)ine levels >2 4.4 mu mol/L) is a risk factor that can be modified for the development of cardiovascular disease in patients on chronic hemodialysis.