Hyperhomocysteinaemia is not associated with isolated crural arterial occlusive disease: The Hoorn Study

Objectives. Hyperhomocysteinaemia is an independent risk factor for periphe ral arterial disease (PAD). The localization of peripheral arterial disease is clinically relevant, because proximal (aortoiliac and femoropopliteal) disease is associated with a particularly poor overall prognosis, whereas i solated distal (i.e. crural) disease is associated with a better overall pr ognosis. The aim of the study was to investigate whether the strength of th e association between hyperhomocysteinaemia and peripheral arterial disease differs according to the localization of the anatomical obstruction. Design. Fasting serum total homocysteine (tHcy) was measured in an age-, se x- and glucose-tolerance stratified random sample (n = 631) of a 50- to 75- year-old general Caucasian population. History of a peripheral arterial rec onstruction was recorded. Aortoiliac, femoropopliteal and crural arterial o bstructions were registered by means of Doppler flow velocity curves. Results. The median serum tHcy level was 12.2 mu mol L-1 (interquartile ran ge: 10.0-15.3) in men and 10.7 mu mol L-1 (interquartile range: 9.0-13.3) i n women. The prevalences of aortoiliac, femoropopliteal and crural obstruct ions were 2.1%, 2.7% and 11.9%, respectively. After adjustment for age, sex , systolic blood pressure, current smoking, serum cholesterol and diabetes mellitus, the odds ratios (95% confidence interval) per 5 mu mol L-1 tHcy i ncrement were 1.41 (1.05-1.89) for aortoiliac, 1.03 (0.70-1.52) for femorop opliteal and 0.82 (0.59-1.15) for crural obstructions. Finally, diabetes me llitus, HbA(1c) and current smoking were significantly associated with crur al and femoropopliteal disease, whereas systolic blood pressure was signifi cantly associated with aortoiliac obstructions. Conclusions. The present study indicates that hyperhomocysteinaemia is asso ciated with aortoiliac but not with isolated crural arterial occlusive dise ase.