Homocysteine enzymatic

Improving cardiovascular risk prediction to support treatment decisions

Cardiovascular disease (CVD) is a major health concern that continues to grow. CVD is already responsible for more deaths globally than any other disease and the huge burden it places upon healthcare systems and society is predicted to become even greater.

30% of cardiovascular disease associated mortality occurs in individuals without elevated, conventional risk factors. Therefore, there is a clinical need to expand the number of available diagnostic tools for evaluating an individual’s risk of CVD.¹

Homocysteine is a strong, independent risk factor for cardiovascular disease

Numerous clinical and epidemiologic studies have established elevated blood homocysteine (HCY) as a potent independent risk factor for vascular disease²:

Subsequent observations from approximately 80 clinical and epidemiologic studies have demonstrated that hyperhomocysteinemia is an independent, dose-dependent risk factor for atherosclerotic vascular disease and for arterial and venous thromboembolism³
For example, moderate to intermediate hyperhomocysteinaemia is present in 12 - 47% of patients with coronary, cerebral, or peripheral arterial occlusive diseases²

Homocysteine is an early risk marker for high-risk patients

Meta-analysis of 72 studies has demonstrated significant associations between homocysteine and the risk of ischaemic heart disease, deep vein thrombosis, pulmonary embolism and stroke. The results of the meta-analysis provide further strong evidence for a causal relationship between elevated homocysteine and CVD⁴
Modest reduction of homocysteine is predicted to lower the risk of CVD up to 25%⁴

Fig. Predicted decrease in CVD risk following reduction in blood total homocysteine concentration.⁴ Whiskers represent the upper and lower 95% confidence intervals for the calculated decrease in risk.

Homocysteine provides additional prognostic information over cholesterol

Numerous studies have shown the connection between HCY levels and atherosclerosis. A concentration-dependent correlation between HCY and cardiovascular risk has been established from the Framingham study.⁵ A 5 μmol/L increase in HCY is equivalent to approx.
1.1 mmol/L increase in total cholesterol level.⁶

Homocysteine as a risk factor for coronary heart disease

Boushey, et al., performed a meta-analysis of 27 clinical studies, and summarised the odds ratio between elevated HCY and development of vascular disease. The authors found an OR of 1.6 (95 % CI, 1.4 to 1.7) for men and 1.8 (95 % CI, 1.3 to 1.9) for women for a 5-μmol/L HCY increment, suggesting that about 10 % of the population’s CHD risk appears attributable to HCY.⁶ This stimulated clinical investigations of HCY as a risk factor for coronary heart disease (CHD) and its use in clinical patient care.

Abbreviation:

CI = confidence interval, OR = odds ratio

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References

Vilahur, G., Badimon, J., Bugiardini, R., Badimon, L. (2014). Perspectives: the burden of cardiovascular risk factors and coronary heart disease in Europe and worldwide. European Heart Journal Supplements 16 (Suppl A), A7-A11.
Kang, S.S. et al. (1992). Hyperhomocyst(e)inemia as a risk factor for occlusive vascular disease. Ann Rev Nutr. 12, 279-298.
Refsum, H., Ueland, P.M., Nygard, O., Vollset, S.E. (1998). Homocysteine and cardiovascular disease. Annu Rev Med 49, 31–62.
Wald, D.S., Law, M., Morris, J.K. (2002). Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ 325, 1202.
McCully, K.S. (2007). Homocysteine, vitamins, and vascular disease prevention. Am J Clin Nutr. 86 (suppl), 1563-1568.
Boushey, C.J. et al. (1995). A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 274(13), 1049-57.