ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):189-99

Copyright © 2001 EDIZIONI MINERVA MEDICA

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.