Homocysteine: An independent risk factor for the failure of vascular intervention

Abstract

Hyperhomocysteinaemia is an independent risk factor for the early development of arterial disease. Homocysteine and cardiovascular risk factors were assessed in 41 young and 25 older patients with vascular disease. As homocysteine may act by the generation of free radicals, total antioxidant capacity was measured. Hyperhomocysteinaemia was found in 29 per cent of patients but there was no difference between young and older patients. Homocysteine level was unrelated to other cardiovascular risk factors. Young age, diabetes and hyperhomocysteinaemia were independent risk factors for the failure of vascular procedures (P = 0.006). Patients with hyperhomocysteinaemia had raised total antioxidant capacity. The potential of identifying and treating a subgroup of patients with a poor prognosis deserves further study.

The prevalence of thrombophilia in patients with symptomatic peripheral vascular disease

“…Thrombophilia defects are associated with failed revascularization in patients with peripheral vascular disease; the data suggest that the failure rate may be over three times higher than in patients without such defects1–9. Studies also suggest that hyperhomocysteinaemia is associated with vein graft stenosis10–12. Thrombophilia and hyperhomocysteinaemia appear to be commoner in patients with peripheral vascular disease than in the general population10–23.…”

“…Studies also suggest that hyperhomocysteinaemia is associated with vein graft stenosis10–12. Thrombophilia and hyperhomocysteinaemia appear to be commoner in patients with peripheral vascular disease than in the general population10–23. The overall prevalence of thrombophilia defects and hyperhomocysteinaemia are difficult to calculate, as many of the studies were carried out in heterogeneous vascular populations or in early‐onset disease.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…Approximately 30% to 40% of patients with lower extremity PAD have high levels of homocysteine (5). Elevated homocysteine levels are prevalent in both younger and elderly patients with lower extremity PAD (70,71). Approximately 25% of patients with intermittent claudication have plasma homocysteine levels exceeding the 95th percentile (72).…”

Homocysteine: An aetiological contributor to peripheral vascular arterial disease

“…While conclusive evidence from intervention trials, such as the vitamins to prevent stroke (VITATOPS) study, regarding the therapeutic benefit of lowering Hcy levels in the setting of vascular disease is still forthcoming, given the extensive body of literature supporting a causal role for elevated Hcy in vascular disease and its relative ease of treatment, a case for preemptive measurement and intervention can be strongly argued 1−5,18 ,. 20,21 , 26,27 …”