Homocysteine and cardiovascular risk in patients with diabetes mellitus

Background and Aim: Diabetes mellitus is the most common metabolic disorder in the Western world with coronary artery disease as its leading cause of mortality. Conventional coronary risk factors do not explain the high morbi dity rare and there is strong evidence linking hyperhomocystinemia and prem ature atherosclerosis. Therefore, we reviewed the relationship between homo cysteine and diabetes mellitus. Data synthesis: The literature dealing with diabetes mellitus, B vitamins a nd metformin was reviewed. Some studies show higher than normal fasting and postmethionine load levels of plasma homocysteine in diabetes patients, pa rticularly in those with nephropathy and microalbuminutia. Metformin use an d low plasma B vitamins are other potential mechanisms resulting in hyperho mocysteinemia in these patients. Conclusions: Abnormal homocysteine concentration is prevalent in subsets of diabetic patients; its relationship with excess cardiovascular morbidity i s not yet clear Consequently: large prospective studies are essential in or der to follow the effects of homocysteine and its normalization on accelera ted artherosclerosis in diabetes. (C) 2001, Medical Press.