Hyperhomocyst(e)inemia is associated with carotid atherosclerosis

The atherogenicity of homocyst(e)ine-H(e) -emerged from many studies showin g an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosi s was defined as an intimal media thickness of internal and carotid bifurca tion of at least 2 mm on the near and far walls as determined by B-mode ult rasonography. The study population included 91 patients: group 1 (61% males , mean age 64 +/- 10 years, 57% with history of hypertension) with ultrasou nd evidence of carotid atherosclerosis and 100 with normal carotid walls-gr oup 2 (36% males, mean age 52 +/- 15 years, 27% with history of hypertensio n). Homocyst(e) ine levels (mu mol/L) were determined by high-performance l iquid chromatography with a fluorescent detector. Body mass index, dyslipid emia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B- 12 were not significantly different in the two groups. Homocyst(e)ine level s (mu mol/L) were significantly higher in patients with carotid atheroscler osis than in those with normal arteries (11.7 +/- 6.5 mu mol/L, 95% CI 10.4 -13.1 vs 8.07 +/- 4.4 mu mol/L, 95% CI 7.2-8.9, p < 0.0001). By multiple re gression analysis H(e) levels were positively correlated with male gender ( p < 0.02), age (p < 0.001), and negatively with folic acid (p < 0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x 10 years, OR 2.1 5) and H(e) levels (x I mu mol/L, OR 1.11). This study confirmed homocyst(e)ine is associated with carotid atherosclero sis. Consequently the authors recommend H(e) levels be screened in all pati ents at risk for atherosclerosis.