Plasma total homocysteine and cardiovascular risk in patients submitted to liver transplantation.
Patients submitted to orthotopic liver transplantation (OLT) show an increased rate of cardiovascular events. OLT subjects have high homocysteine (Hcy) levels, but no data are available on the association of Hcy with cardiovascular events. In a cross-sectional analysis, 230 subjects were studied at least 6 months after OLT (159 on cyclosporine, 71 on tacrolimus). Routine laboratory data and total Hcy were recorded, as well as the history of diabetes, hypertension, dyslipidemia, and overweight. Cardiovascular events occurring in a follow-up of 2-36 months were registered. OLT subjects had higher-than-normal Hcy (median 16.7 micromol/L, range 6.1-171.8) without difference between the 2 immunosuppressive agents. The prevalence of Hcy >15 micromol/L was also similar, and significantly correlated with creatinine levels. A total of 28 arterial events occurred in 25 patients during follow-up (11 in coronary arteries, 10 in peripheral arteries, and 7 in splanchnic arteries). Deep vein thromboses occurred in 2 patients, and splanchnic vein thromboses in 4 patients. Cardiovascular events were frequently associated to high Hcy and hypertension. Cox regression analysis showed that high Hcy was significantly associated with arterial events. The risk of any arterial event, coronary artery or peripheral artery event increased by nearly 10% for any increase in Hcy of 5 micromol/L. In conclusion, high Hcy may be involved in the pathogenesis of cardiovascular events in OLT patients. The usefulness of Hcy-lowering therapy remains to be verified.
Bianchi
Giampaolo
G
Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. bianmice@almadns.unibo.it
Nicolino
Francesco
F
Passerini
Giorgia
G
Grazi
Gian Luca
GL
Zappoli
Paola
P
Graziani
Romina
R
Berzigotti
Annalisa
A
Chianese
Raffaela
R
Mantovani
Vilma
V
Pinna
Antonio Daniele
AD
Zoli
Marco
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011300:Preoperative Care; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014181:Transplantation Immunology / Q000187:drug effects; D016896:Treatment Outcome
D015415:Biomarkers; D007166:Immunosuppressive Agents; D006710:Homocysteine