Relationship among Homocyst(e)ine, Vitamin B-12 and Cardiac Disease in the Elderly: Association between Vitamin B-12 Deficiency and Decreased Left Ventricular Ejection Fraction

Herzlich, Barry C.; Lichstein, Edgar; Schulhoff, Nancy; Weinstock, Martin A.; Pagala, Murali; Ravindran, K.; Namba, Tatsuji; Nieto, F. Javier; Stabler, Sally P.; Allen, Robert H.; Malinow, M. R.

doi:10.1093/jn/126.suppl_4.1249s

Cited by 33 publications

(17 citation statements)

References 20 publications

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“…2), or the hyperhomocysteinemia rate (Table 3) with CAD extent could be found. Therefore, no tight or graded relationship of tHcy with the CAD extent existed in these high-risk women, in accordance with several [4,7,13,[36][37][38][39], albeit not all [40,41], available data. Environmental and dietary factors [42], along with genetic differences, can explain these conflicting findings.…”

Section: Hyperhomocysteinemia and Coronary Artery Diseasesupporting

confidence: 70%

Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women

Rossi¹,

Maiolino²,

Seccia

et al. 2006

Journal of Hypertension

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Section: Hyperhomocysteinemia and Coronary Artery Diseasesupporting

confidence: 70%

Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women

Rossi¹,

Maiolino²,

Seccia

et al. 2006

Journal of Hypertension

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“…Previous data on the relationship of LVEF and tHcy were limited and conflicting: in elderly CAD patients, an inverse relation was reported, 24 but a positive (rϭ0.13; PϽ0.001) 7 or no correlation was also described. 25 Accordingly, our detection of an inverse relationship between tHcy and LVEF is novel and might explain the association of HHcy with CV mortality, 38 inasmuch as LVEF is a powerful determinant of survival.…”

Section: Relationship Of Hhcy With LV Ejection Fractionmentioning

confidence: 98%

“…23 However, data on the impact of HHcy on LV function are limited and conflicting. 7,24,25 Thus, in the arterial hypertensive and normotensive patients of the Genetic and Evironmental Factors in Coronary Atherosclerosis (GENICA) study, 26 …”

Section: Conclusion-inmentioning

confidence: 99%

Hyperhomocysteinemia Is Inversely Related With Left Ventricular Ejection Fraction and Predicts Cardiovascular Mortality in High-Risk Coronary Artery Disease Hypertensives

Cesari

Zanchetta

Burlina

et al. 2005

ATVB

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Objective-The purpose of this study was to investigate the relationship of plasma homocysteine (tHcy) levels with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) in high-risk patients undergoing coronary angiography for suspected CAD. Methods and Results-In 936 consecutive patients, we measured LVEF, tHcy, folate levels, and quantified CAD with a modified Duke Index score. We also genotyped patients at the methylen-tetrahydrofolate-reductase 677C3 T polymorphism. Hyperhomocysteinemia (HHcy) was defined as tHcy levels Ն15.46 mol/L; total and cardiovascular mortality was assessed at follow-up that lasted 43 months (median). CAD was confirmed in 75% of patients and ruled out in the rest (non-CAD group). No relationship of HHcy with either arterial hypertension or the CAD score was found. In contrast, there was a significant inverse relationship of tHcy with LVEF in arterial hypertensive but not in normotensive patients, regardless of previous myocardial infarction. At logistic regression, HHcy was the strongest predictor (Pϭ0.001) of a low (Ͻ40%) LVEF, followed by type 2 diabetes mellitus and cigarette smoking. At follow-up, HHcy significantly predicted cardiovascular mortality but only in the arterial hypertension subgroup. Key Words: homocysteine Ⅲ arterial hypertension Ⅲ coronary artery disease Ⅲ survival Ⅲ MTHFR 677C3 T polymorphism Ⅲ left ventricular ejection fraction H yperhomocysteinemia (HHcy) might play a causative role in the development of coronary artery disease (CAD) and cardiovascular (CV) disease 1 and originates from an interplay of environmental factors, such as folate and B 12 vitamin deficiency, and genetic factors, including the thermolabile variant (677C3 T) of methylen-tetrahydrofolatereductase (MTHFR) gene. 2,3 On the basis of plasma homocysteine (tHcy) concentrations, HHcy has been classified as mild/moderate (15 to 30 mol/L), intermediate (30 to 100 mol/L), and severe (Ͼ100 mol/L). 4 Mild/moderate HHcy is common (5% to 7%) in the population and might increase the risk of CV disease, 3,5,6 but its association with such phenotype is weaker than that of severe HHcy. Prospective studies in high-risk subjects suggested that HHcy can be a risk factor for overall mortality, 7 recurrent CV events, and hospitalization, 8 but studies of healthy subjects did not confirm this contention. 8 -10 Thus, it would appear that mild/ moderate HHcy plays a minor role for CV disease and might attain a greater importance only in high-risk patients. Conclusions-InTheoretically, HHcy could increase blood pressure by decreasing the endothelial production of NO, inducing accumulation of the endogenous NO synthase inhibitor asymmetrical dimethylarginine, 11 or lowering NO bioactivity through induction of oxidative stress. 12,13 Nonetheless, only a weak association between HHcy and arterial hypertension was found, 14 -18 and there are no data in high-risk patients.HHcy can exert nefarious effects on the heart by inducing coronary arteriolar remodeling, left ventricular (LV) hypertrophy,...

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“…Negative (31)(32)(33), positive (34), and no association (35) of plasma homocysteine with LV ejection fraction have been reported in referral samples of patients with coronary artery disease. Hermann and colleagues have reported a positive correlation of plasma homocysteine with LV internal dimensions and an inverse relation to ejection fraction in a series (ns1552) by sex-specific quartiles of plasma homocysteine, adjusted for age, height, weight, total/HDL-cholesterol ratio, systolic blood pressure, antihypertensive treatment, diabetes, valve disease, heart rate and serum creatinine.…”

Section: Plasma Homocysteine and Left Ventricular Mass And Functionmentioning

confidence: 99%

Homocysteine and heart failure: a review of investigations from the Framingham Heart Study

Sundström

Vasan

2005

Clinical Chemistry and Laboratory Medicine (CCLM)

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High plasma homocysteine levels are associated with a moderately increased risk of cardiovascular disease, particularly of atherosclerotic events. We review the association of plasma homocysteine with heart failure, with a specific focus on a series of previously published investigations from the community-based Framingham Heart Study that evaluated the relations of plasma homocysteine levels with overt heart failure, and with its key antecedents, echocardiographic left ventricular (LV) mass and hypertension. In the Framingham sample, higher plasma homocysteine levels were associated with increased risk of new-onset heart failure in both men and women, with a more continuous and graded relation being observed in women. A positive relation between homocysteine and LV mass was observed in women, but not in men; this may underlie the stronger relations of homocysteine to heart failure risk in women. Plasma homocysteine was not associated with hypertension incidence prospectively in either sex. The relations of increased homocysteine to heart failure (in both sexes) and to greater LV mass (in women) noted in the Framingham sample should be confirmed in other community-based samples. Secondary analyses of heart failure outcomes in ongoing randomized clinical trials may provide insights into whether lowering of plasma homocysteine levels is associated with a reduction in LV mass and/or a reduction of heart failure risk.

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Relationship among Homocyst(e)ine, Vitamin B-12 and Cardiac Disease in the Elderly: Association between Vitamin B-12 Deficiency and Decreased Left Ventricular Ejection Fraction

Cited by 33 publications

References 20 publications

Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women

Hyperhomocysteinemia predicts total and cardiovascular mortality in high-risk women

Hyperhomocysteinemia Is Inversely Related With Left Ventricular Ejection Fraction and Predicts Cardiovascular Mortality in High-Risk Coronary Artery Disease Hypertensives

Homocysteine and heart failure: a review of investigations from the Framingham Heart Study

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