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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2002 June;9(2):125-37

language: English, Italian

Prevalence of total plasma homocyst(e)ine in patients with occlusive and peripheral arterial disease

Lorenzi G., Costantini A. *, Belletti S. *, Crippa M. *, Molinari A. *, Corbetta C., Melotti D. **

From the Unità Operativa di Chirurgia Vascolare Ospedale di Lecco - Lecco
* Istituto di Chirurgia Vascolare e Angiologia
** Laboratorio Ricerche Cliniche, Istituti Clinici di Perfezionamento Università ­degli Studi - Milano


Background. The inter­est in hyper­hom­o­cyst(e)­inemia (hyperHcy) has ­been mark­ed­ly ­increased by sev­er­al clin­i­cal stud­ies ­designed to dem­on­strate its ­role as a ­risk fac­tor in the pres­ence and pro­gres­sion of cere­bral and periph­er­al occlu­sive arte­ri­al dis­ease.
Methods. Total plas­ma homo­cyst(e)ine (tHcy) lev­els ­were meas­ured in 648 ­patients admit­ted for periph­er­al or carot­id occlu­sive arte­ri­al dis­ease, or abdom­i­nal aor­tic aneu­rysm. The con­trol ­group com­prised 111 appar­ent­ly ­healthy ­blood ­donors, (67 men, 44 wom­en). In the ­patient ­group the cut-off val­ue for tHcy was ­fixed at the 97th per­cen­tile (12.71 µmol/l for men and 12.22 µmol/l for wom­en). In a sub­group of ­patients the vita­min stat­us lev­el was test­ed, ­while in a ­group of 35 ­patients the prev­a­lence of meth­yl­enet­e­tra­hy­drof­o­late reduc­tase (­MTHFR) defi­cien­cy was detect­ed.
Results. Two hun­dred and fif­ty-one of 648 ­patients (38.7%) ­were ­found to ­have hyperHcy. Two hun­dred 2 of 343 ­patients (58.8%) suf­fered ­from periph­er­al arte­ri­al dis­ease. Thirty-­five of 180 ­patients (19.4%) pre­sent­ed ­with carot­id ­artery sten­o­sis and 14 of 125 ­patients (11.2%) had abdom­i­nal aor­tic aneu­rysm. Folic ­acid and B12 vita­min lev­els ­were sig­nif­i­cant­ly low­er in the ­patient ­group (56 and 15%, respec­tive­ly). Prevalence of ­MTHFR ­gene muta­tion was 80% in a ­small sub­group of ­patients on genet­ic test­ing.
Conclusions. The find­ings con­firm the ­high prev­a­lence of hyperHcy in ­patients ­with arte­ri­al dis­ease, par­tic­u­lar­ly in ­those suf­fer­ing ­from periph­er­al occlu­sive arte­ri­al dis­ease. Further ­research ­should be direct­ed ­toward defin­ing the prev­a­lence and ­role of genet­ic muta­tion in ­this dis­ease. Based on ­these ­results, ran­dom pros­pec­tive ­trials ­should be con­duct­ed to deter­mine wheth­er the expect­ed reduc­tion of tHcy ­with vita­min sup­ple­men­ta­tion is ­also asso­ciat­ed ­with slow­er pro­gres­sion of the dis­ease.

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