Ischemic heart disease homocysteine

Homocysteine Studies Collaboration (2002) Homocysteine and risk of ischemic heart disease and stroke a meta-analysis. JAMA 288 2015-2022... 

There may be an added benefit for adults. N 5-methyltetrahydrofolate is required for the conversion of homocysteine to methionine (Figure 33-1 Figure 33-2, reaction 1). Impaired synthesis of N 5-methyltetrahydrofolate results in elevated serum concentrations of homocysteine. Data from several sources suggest a positive correlation between elevated serum homocysteine and occlusive vascular diseases such as ischemic heart disease and stroke. Clinical data suggest that the... 

Moderately elevated plasma homocysteine, defined as levels between 15 and 30 jimol/L (5), has emerged as a new risk factor for ischemic heart disease and stroke (6). 

Many studies published during the last few decades have suggested that hyperhomocysteinemia is a risk factor for coronary artery disease (CAD), stroke, and thromboembolic disease. The Homocysteine Studies Collaboration metaanalysis of 30 studies concluded that elevated tHcy is a moderate risk factor for ischemic heart disease a level 3 xmol/L lower reduces the risk with an odds ratio of 0.89 (95% Cl = 0.83-0.96). The same was true for homocysteine as a risk factor for stroke (odds ratio = 0.81 95%5CI = 0.69-0.95) (6). A meta-analysis of 40 studies of the MTHFR 677 C > T polymorphism demonstrated a mildly increased risk of coronary heart disease with an odds ratio of 1. 16 (95% Cl = 1.05-1.28) (25). 

Marcucci R, et al. Tissue factor and homocysteine levels in ischemic heart disease are associated with angiographically documented clinical recurrences after coronary angioplasty. Thromb Haemost 2000 83(6) 826-832. 

To assess the relationship of Hey concentrations with vascular disease risk, a meta-analysis of observational studies was carried out, showing that elevated Hey is at most a modest independent predictor of ischemic heart disease and stroke risk in healthy populations. Studies of the impact on disease risk of genetic variants that affect blood Hey concentrations will help determine whether Hey is causally related to vascular disease, as may large randomized trials of the effects on ischemic heart disease and stroke of vitamin supplementation to lower blood Hey concentrations (Homocysteine Studies Collaboration 2002). 

Large meta-analyses have demonstrated that the homozygous C677T MTHFR polymorphism is associated with a higher risk of ischemic heart disease, stroke and deep vein thrombosis, which probably is mediated through raised homocysteine. 

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