[Hyperhomocysteinemia in coronary artery diseases. Apropos of a study on 102 patients].
Homocystein is at the crossroads of the metabolic pathways of sulphuric amino acids. Homocystinuria is a congenital autosomal recessive disease, usually related to cystathionine beta-synthetase deficiency. Children with homozygotic forms of the disease have early vascular complications which represent the main cause of death. Moderately elevated serum homocystein levels are related to two major genetic factors (heterozygotic cystathionine beta-synthetase deficiency and mutation of the 5-10 methylene tetrahydrofolate reductase) and several minor, genetic and non-genetic factors (folic acid, vitamins B6 and B12 and betain deficiencies). Previous studies have suggested that hyperhomocysteinaemia could be a cardiovascular risk factor. This study was based on 222 subjects including 102 consecutive patients with angiographically documented coronary artery disease and 120 control subjects without vascular disease. No relationship was observed between serum homocystein concentrations and the classical cardiovascular risk factors. Coronary patients had higher average homocystein concentrations than control subjects (11.27 +/- 0.52 vs 8.77 +/- 0.31 mumol/l); p < 0.0001): moreover, the prevalence of hyperhomocysteinaemia (> 15.67 mumol/l) was higher in the coronary group (15.7%) than in the controls (2.5%). A significant relationship was also observed between homocystein concentrations and the severity of the coronary disease (defined by a coronary score) and the number of diseased vascular territories. These results underline the relationship between homocystein and vascular risk, especially that of coronary artery disease. The treatment of hyperhomocysteinaemia by folic acid supplements is effective in correcting plasma levels, without side effects and at a relatively low cost.
Blacher
J
J
Service de cardiologie, hôpital Pitié-Salpêtrière, Paris.
Montalescot
G
G
Ankri
A
A
Chadefaux-Vekemans
B
B
Benzidia
R
R
Grosgogeat
Y
Y
Kamoun
P
P
Thomas
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006397:Hematinics / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index
D006397:Hematinics; D006710:Homocysteine; D005492:Folic Acid
Hyperhomocystéinémie chez des patients coronariens. A propos d'une étude portant sur 102 sujets.