title: Total serum homocysteine--a predictor of extracranial carotid artery stenosis in male patients with symptomatic peripheral arterial disease.
abstract: High total serum homocysteine (tHcy) concentrations are associated with an increased risk of carotid artery disease in the general population. Since patients with peripheral arterial disease (PAD) have a threefold risk of cerebrovascular morbidity compared to individuals free of PAD, and since the total neurological event rate is associated with a > or = 50% lumen reduction in extracranial carotid arteries, it was tested whether tHcy is a predictor of internal carotid artery stenosis in patients with symptomatic PAD. A total of 443 consecutive male PAD patients without previous carotid surgery/stenting were studied. In all, 100 patients with PAD had an internal carotid artery stenosis > or = 50%. Of the remaining 343 patients, 100 individuals matched for age (+/- 2 years) and diabetes served as controls. The extent of carotid stenosis was evaluated with color duplex measurement; tHcy was determined by high-performance liquid chromatography. Cases displayed a significantly higher median fasting tHcy level (17.0 micromol/l) than controls (13.7 micromol/l, p=0.001). Multivariate analysis showed that tHcy (p=0.036) was an independent predictor of internal carotid artery stenosis > or = 50% in PAD patients, representing an odds ratio of 1.32 (95% CI, 1.02-1.72) for an increment of 5 micromol/l. In the present study, high tHcy was an independent risk factor for an internal carotid artery stenosis > or = 50% in patients with PAD. Since PAD patients suffer a threefold risk of stroke compared to healthy individuals, a simple vitamin substitution in PAD patients may reduce the occurrence of internal carotid artery stenosis and therefore diminish the relatively high rate of cerebrovascular events in this population.
authors.affiliation: Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Mueller
authors.forename: B
authors.initials: B
authors.lastname: Furtmueller
authors.forename: J
authors.initials: J
authors.lastname: Aigelsdorfer
authors.forename: C
authors.initials: C
authors.lastname: Luft
authors.forename: W
authors.initials: W
authors.lastname: Poelz
authors.forename: M
authors.initials: M
authors.lastname: Haltmayer
mesh_terms: D000368:Aged; D001158:Arteries; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D005544:Forecasting; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D014652:Vascular Diseases / Q000097:blood* / Q000150:complications*
chemical_list: D006710:Homocysteine