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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):189-99
language: English, Italian
Hyperhomocysteinemia in patients with adbominal aortic aneurysms: a new pathogenetic factor?
Pratesi C., Pulli R., Dorigo W., Lombardi R., Brunelli T. *, Fedi S. *, Pepe G. *, Rogolino A. *, Giusti B. *, Marcucci R. *, Farsi A. *, Prisco D. *, Abbate R. *
From the Department and School of Specialisation in Vascular Surgery
* Institute of Clinical Medicine University of Florence, Florence, Italy
Background. To evaluate changes in the plasma levels of homocysteine in patients with abdominal aortic aneurysms compared to healthy controls and patients with polydistrict atherosclerosis.
Methods. A total of 47 patients were examined from 1 April 1997 to 31 July 1998, undergoing endoaneurysmectomy and graft following aneurysm of the infrarenal abdominal aorta. This group was compared to 73 patients with polydistrict atherosclerosis and 58 control subjects. Having evaluated the clinical characteristics of all patients and the incidence of the various risk factors and associated pathologies, the plasma level of homocysteine was determined in all three groups using liquid chromatography, as well as the frequency of C677T mutation in the gene codifying enzyme 5-10 MTHFR through the assay of genomic DNA. The statistical analysis of data was performed with parametric tests (ANOVA), using multivariate analysis to determine the correlation between the pathology and risk factors.
Results. The plasma levels of homocysteine were significantly higher in patients with AAA compared to both polydistrict atherosclerotic patients and controls. Multivariate analysis showed that homocysteine is an independent risk factor for abdominal aortic aneurysm. The prevalence of homozygous subjects for C677T mutation in the gene of enzyme 5-10 MTHFR was higher, but not statistically significant in patients affected by abdominal aortic aneurysms. The presence of mutation in the MTHFR gene, and in particular the homozygous genotype, was significantly associated with homocysteine plasma levels.
Conclusions. These results suggest that hyperhomocysteine plays a pathogenic role in patients with abdominal aortic aneurysm, offering major opportunities from a therapeutic point of view, for the reduction of homocysteine levels and prevention of endothelial damage.