Screening of plasma homocysteine in peripheral arterial disease

BACKGROUND. Homocysteine (HCY) was recently established as an independent r isk factor for atherosclerosis, The prevalence of an increased homocysteine plasma concentration was reported to be up to 6-fold higher in patients wi th different locations of arterial occlusive diseases. AIM. This study evaluated critically whether the total HCY plasma concentra tion can be used as a screening marker for peripheral arterial disease in t he general population. METHODS. Study subjects were 40 patients (51.8 +/- 7.5 years) with symptoma tic lower limb peripheral arterial disease (PAD) (stage II) and 40 healthy volunteers (45.6 +/- 6.8 years, P < 0.05 vs PAD). The percentage of women i n both groups was 30%. The plasma HCY concentration was determined by using derivatization techniques and subsequent fluorescence high-performance liq uid chromatography. RESULTS. Total plasma HCY concentration was significantly higher in the PAD group than in controls (14.90 +/- 5.78 CIM vs 11.32 +/- 2.95 <mu>M, respec tively, P < 0.001). Also, the coefficient of variation of plasma HCY in PAD was significantly higher than that in the control group. 0.38 vs 0.25 (P < 0.001), respectively, reflecting greater interindividual differences. In a ddition to a PAD-specific effect, the plasma HCY concentration was also dep endent on gender and age (both P < 0.05). Sensitivity and specificity of HC Y as a marker of PAD were 0.3 and 0.95, respectively. Positive and negative predictive values were 0.85 and 0.42, respectively. CONCLUSIONS, From these data it is concluded that HCY metabolism may have a n influence on the development of PAD in one-third of all patients with PAD , and that total plasma HCY concentration may not be suited as a screening test for PAD in the general population but rather serves as a monitoring ma rker in certain risk groups.