Plasma homocysteine and severity of thoracic aortic atherosclerosis

Study objectives: Plasma homocysteine level is a risk factor for coronary e vents, stroke, and peripheral atherosclerotic disease. However, few data ar e available concerning the relationship between homocysteine level and seve rity of thoracic aortic atherosclerosis, We hypothesized in this multiplane transesophageal echocardiography (TEE) study that homocysteine level is a marker of the presence and severity of thoracic aortic atherosclerosis. Design: Cross-sectional study. Setting: University hospital. Patients: Risk factors, angiographic features, and TEE findings were analyz ed prospectively in 82 valvular patients. Measurements and results: The following risk factors were recorded: age, ge nder, hypertension, smoking, lipid parameters, diabetes, body mass index, a nd family history of coronary artery disease. Plasma levels of homocysteine , vitamin B-12, and folic acid were measured for each patient. By univariat e analysis, age, diabetes, hypertension, smoking, family history of coronar y artery disease, and levels of homocysteine, total cholesterol, low-densit y lipoprotein cholesterol, and high-density lipoprotein cholesterol were si gnificant predictors of the presence of thoracic aortic plaques. There was a positive correlation between the plasma homocysteine levels and the score of severity of thoracic atherosclerosis (r = 0.48; p = 0.0001) as well as between the homocysteine levels and the grades of severity of aortic intima l changes (p = 0.0008). Multivariate regression analysis revealed that homo cysteine was an independent predictor of the presence and severity of thora cic aortic atherosclerosis, Conclusion: This prospective study indicates that plasma homocysteine level is a marker of severity of thoracic atherosclerosis detected by multiplane TEE. These findings emphasize the role of homocysteine as a marker of athe rosclerotic lesions in the major arterial locations.