Homocysteine plasma levels in young patients with coronary artery disease - Relation to history of acute myocardial infarction and anatomical extent of disease

Although there is considerable epidemiologic evidence for a relationship be tween plasma homocysteine (Hcy) levels and cardiovascular disease, not all prospective studies have shown such a relationship. Furthermore, data conce rning the role of hyperhomocysteinemia in patients with premature coronary artery disease (CAD) are rare. It was the aim of the study to investigate a possible association between Hcy plasma levels in young patients with the extent of CAD and the history of myocardial infarction (MI). A cohort of 94 patients was examined for conventional risk factors and the history of pre vious transmural MI. Furthermore, coronary angiography was performed to ass ess the anatomical extent of vessel disease. Plasma Hcy levels were measure d by use of a commercial enzyme-linked immunosorbent assay. Only a history of previous MI was significantly associated with hyperhomocysteinemia. Ther e was no relationship between elevated Hcy levels and the anatomical extent of vessel disease in patients with premature CAD. Our data may indicate th at hyperhomocysteinemia represents an independent risk factor for acute cor onary thrombosis rather than for the development of coronary sclerosis. The reby, hyperhomocysteinemia may influence the clinical situation after plaqu e rupture not only by prothrombotic action but also by favouring endothelia l dysfunction and vasospasm. (C) 2001 Elsevier Science Ltd. All rights rese rved.