[Homocysteine and cardiovascular disease: what is the connection?].
HYPERHOMOCYSTEINEMIA: There are experimental data arguing for a role of homocysteine in several processes involved in atherosclerosis. Multiple retrospective and prospective studies performed in populations with high cardiovascular risk have shown that high homocysteine levels are associated with increased risk of coronary artery disease, stroke and peripheral vascular disease. In populations free of cardiovascular disease, prospective studies have demonstrated that homocysteine is a risk factor for cardiovascular disease while in other publications, no such prognostic value is found for high serum levels of homocysteine. PERSPECTIVE AND PREVENTION: There are highly promising perspectives for prevention due to the fact that serum homocysteine levels fall off systematically after simple dietary supplementation with vitamin B. Nevertheless, there is no formal proof to date from therapeutic trials suggesting that such a supplementation would reduce the risk of cardiovascular disease. FURTHER INFORMATION REQUIRED: In terms of epidemiology and clinical expression, further research into homocysteine as a cardiovascular risk factor should not be based on case-control studies which can be expected to provide information of limited usefulness, but rather on interventional trials to determine the primary or secondary preventive effect on cardiovascular disease. A large-scale pragmatic study using diet supplementation in a wide population might provide answers to still open questions.
Blacher
J
J
Service de Médecine Interne-Thérapeutique, INSERM Unité 337, Hôpital Broussais, Paris. jacques.blacher@brs.ap-hop-paris.fr
Ducimetière
P
P
Safar
M
M
D001161:Arteriosclerosis / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood*; D003327:Coronary Disease / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors