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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2004 March;23(1):35-40


lingua: Inglese

Hyperhomocysteinemia: marker of systemic atherosclerosis in peripheral arterial disease

Taute B. M. 1, Taute R. 1, Heins S. 2, Behrmann C. 3, Podhaisky H. 1

1 Department of Internal Medicine III/Angiology, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany 2 Department of Pediatrics/Research Laboratory, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany 3 Department of Diagnostic Radiology, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany


Aim. ­Patients suf­fer­ing from periph­er­al arte­ri­al dis­ease (PAD) are increas­ing­ly ­described as hav­ing hyper­hom­o­cys­tei­ne­mia more than in ­patients with cor­o­nary ­artery or cereb­ro­vas­cu­lar dis­ease. Cases of symp­to­mat­ic PAD usu­al­ly ­present with asso­ciat­ed cor­o­nary ­artery or cereb­ro­vas­cu­lar dis­ease and renal ­artery dis­ease. It can thus be pos­tu­lat­ed that mul­ti­loc­u­lar ath­ero­scler­o­sis is ­linked to hyper­hom­o­cys­tei­ne­mia and that the ­extent of ath­ero­scler­o­sis has a pos­sible cor­re­la­tion with homo­cys­teine con­cen­tra­tions. The aim of this study was to ascer­tain wheth­er fast­ing total homo­cys­teine con­cen­tra­tions in ­patients with PAD are asso­ciat­ed with the ­extent and the local­iza­tion of system­ic ath­ero­scler­o­sis in cereb­ro­vas­cu­lar, cor­o­nary and/or renal vas­cu­lar zones.
Meth­ods. A total of 183 ­patients with PAD, Fon­taine stag­es II-IV, were divid­ed into 2 ­groups: Group A con­tained ­patients with iso­lat­ed PAD (n=98) and Group B ­patients with system­ic ath­ero­scler­o­sis in PAD (n=85). Char­ac­ter­iza­tion of vas­cu­lar dis­ease in var­i­ous vas­cu­lar zones was indi­ca­tion-adapt­ed using non-inva­sive and/or inva­sive meth­ods. ­Patients with renal insuf­fi­cien­cy were exclud­ed from the study.
­Results. Homo­cys­teine con­cen­tra­tions were sig­nif­i­cant­ly lower in ­patients with iso­lat­ed PAD than in ­patients with addi­tion­al system­ic ath­ero­scler­o­sis (10.1±4.4 vs 16.7±7.04 µmol/l, p<0.0001). There were no dif­fer­enc­es in local­iza­tion or ­extent of con­co­mi­tant system­ic ath­ero­scler­o­sis. Logis­tic regres­sion anal­y­sis indi­cat­ed that ele­vat­ed plas­ma homo­cys­teine and decreas­ing ABPI ­served inde­pen­dent­ly as sig­nif­i­cant risk indi­ca­tors for system­ic ath­ero­scler­o­sis in ­patients with PAD (p<0.0001).
Con­clu­sion. Hyper­hom­o­cys­tei­ne­mia is a pre­cur­so­ral mark­er of system­ic ath­ero­scler­o­sis and thus a prog­nos­tic indi­ca­tor of car­di­o­vas­cu­lar mor­bid­ity and mor­tal­ity in PAD.

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