title: Homocysteine concentrations in type 2 diabetic patients with silent myocardial ischemia: a predictive marker.
abstract: BACKGROUND
  Silent myocardial ischemia (SMI) is a frequent finding among diabetic patients. There are very few data on the relationship between homocysteine, which is a novel cardiovascular risk factor, and SMI in diabetic patients. We investigated whether plasma homocysteine has a predictive value for early diagnosis of SMI in type 2 diabetic patients.
  
  
  METHODS
  One hundred and twenty diabetic patients and 25 control subjects were evaluated. Among diabetic patients, 29 had a history or clinical signs of coronary artery disease (CAD). All other patients who had normal ECGs and no history or clinical signs of CAD were screened by exercise test. Thirty-eight patients with maximal negative exercise test were labelled as CAD (-) diabetic patient group. Angiography was performed on patients who had positive exercise tests and among them 23 patients had angiographically documented SMI.
  
  
  RESULTS
  CAD (+) and SMI groups had significantly higher serum homocysteine concentrations than CAD (-) and control groups (14.2+/-6.6, 15.7+/-7.8, 9.6+/-3.23, 9.3+/-2.25 micromol/l, respectively). In the SMI (+) diabetic group there was a significant correlation between serum homocysteine concentrations and creatinine, microalbuminuria and folic acid levels. Multiple regression analysis showed that homocysteine concentration was dependent on microalbuminuria, folic acid levels and presence or absence of ischemia.
  
  
  CONCLUSIONS
  The present investigation shows an association of homocysteine with SMI in diabetic patients. Other prospective studies are needed to establish whether homocysteine levels can be used as a suitable marker for CAD screening in type 2 diabetic patients.
authors.affiliation: Department of Endocrinology and Metabolism, Kocaeli University, Izmit, Turkey. ilhantarkun@superonline.com
authors.forename: Ilhan
authors.initials: I
authors.lastname: Tarkun
authors.forename: Berrin
authors.initials: B
authors.lastname: Cetinarslan
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Cantürk
authors.forename: Pinar
authors.initials: P
authors.lastname: Tarkun
authors.forename: Ayşen
authors.initials: A
authors.lastname: Agaçdiken
authors.forename: Baki
authors.initials: B
authors.lastname: Komsuoglu
mesh_terms: D000419:Albuminuria / Q000150:complications / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000652:urine; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000097:blood; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005492:Folic Acid / Q000737:chemistry / Q000378:metabolism; D006710:Homocysteine / Q000097:blood* / Q000737:chemistry; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D018579:Patient Selection; D019518:Postprandial Period / Q000502:physiology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012709:Serum Albumin / Q000737:chemistry / Q000378:metabolism; D013997:Time Factors; D014421:Turkey; D014508:Urea / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D012709:Serum Albumin; D006710:Homocysteine; D014508:Urea; D005492:Folic Acid; D003404:Creatinine