title: The screening power of methylenetetrahydrofolate reductase C677T polymorphism versus plasma homocysteine concentration in patients with stenosis of the internal carotid artery.
abstract: BACKGROUND
  Hyperhomocysteinemia is an important and independent risk factor for vascular disease. About 35% of patients with stroke and 47% of patients with peripheral arterial disease have elevated plasma homocysteine (HCY) concentrations. The relationship between plasma HCY and the methylentetrahydrofolate reductase (MTHFR) C677T polymorphism is still unclear, especially in regard to screening/diagnostic power.
  
  
  METHODS
  This case-control study was performed on 96 patients, who underwent surgery due to asymptomatic or symptomatic high grade stenosis of the internal carotid artery (ICA), and 96 healthy age and sex-matched, controls. Plasma HCY concentration was determined using a commercial kit for fully automated analysis (AxSYM, Abbott). The C677T polymorphism of the MTHFR-gene was assessed by PCR.
  
  
  RESULTS
  The mean plasma HCY concentration was significantly higher in the group with stenosis of ICA compared to the controls, 12.43 +/- 6.96 microM and 10.16 +/- 3.16 microM, respectively, (p < 0.05). An HCY plasma concentration of 1.5 SD above the mean value of the control group, was defined as cut-off for a pathological versus physiological plasma concentration. The sensitivity and specificity of HCY was 0.27 and 0.94, respectively. The positive predictive value was 0.82. There was no significant difference in the frequency of the MTHFR 677 CT and TT genotype between patients and controls (47% vs. 47% and 8.3% vs. 11.4%, respectively). Carriers of the T-allele (CT and TT genotypes) have significantly higher plasma HCY concentrations than CC patients, 14.1 +/- 7.6 microM and 10.29 +/- 5.2 microM, respectively, p < 0.05. Sensitivity and specificity of the MTHFR C677T polymorphism (T-allele) were 0.56 and 0.40, respectively. The positive predictive value was 0.48. There was no significant difference in plasma HCY or genotype frequency of the MTHFR C677T polymorphism between asymptomatic and symptomatic patients.
  
  
  CONCLUSIONS
  Our study shows that in a population with a given pretest disease probability of 50%, the determination of plasma HCY concentration, with a positive predictive value of 0.82, is more suitable for screening of patients at risk than analysis of the MTHFR C677T polymorphism.
authors.affiliation: Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center Duesseldorf, Germany. Loncar@med.uni-duesseldorf.de
authors.forename: Robert
authors.initials: R
authors.lastname: Loncar
authors.forename: Barbara T
authors.initials: BT
authors.lastname: Müller
authors.forename: Reiner B
authors.initials: RB
authors.lastname: Zotz
authors.forename: Christof
authors.initials: C
authors.lastname: Sucker
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
authors.forename: Rüdiger E
authors.initials: RE
authors.lastname: Scharf