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Online ISSN 1827-1847
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.
language: English, Italian