This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Al-Obaidi, M. K. Articles by Noble, M. I. M. Search for Related Content PubMed PubMed Citation Articles by Al-Obaidi, M. K. Articles by Noble, M. I. M.

CLINICAL STUDY: ACUTE CORONARY SYNDROMES

Elevated homocysteine levels are associated with increased ischemic myocardial injury in acute coronary syndromes

Mohamed K. Al-Obaidi, MD, MRCP^a, Peter J. Stubbs, MD, MRCP^a, Paul Collinson^*, Ronan Conroy, BMus, Ian Graham, FRCPI and Mark I. M. Noble, DSc, MD^a

^a National Heart and Lung Institute, Cardiology Department, Charing Cross Campus, Imperial College School of Medicine, London, United Kingdom
^* Department of Chemical Pathology, Mayday University Hospital, London, United Kingdom
Department of Epidemiology, Royal College of Surgeons, Dublin, Ireland

Manuscript received November 30, 1999; revised manuscript received March 15, 2000, accepted April 28, 2000.

Reprint requests and correspondence: Dr. M. Al-Obaidi, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.
m.al-obaidi{at}rbh.nthames.nhs.uk

OBJECTIVES

This study was conducted to determine whether the amount of myocardial damage during acute coronary syndromes (ACS) is related to the admission plasma homocysteine concentration.

BACKGROUND

Elevated homocysteine levels are associated with increased thrombosis in patients presenting with ACS. It is not known whether this association is reflected in the degree of myocardial injury in those patients.

METHODS

We studied consecutive patients presenting with acute myocardial infarction (MI) (n = 205) and unstable angina pectoris (UAP) (n = 185). Plasma samples were collected on admission and prior to clinical intervention and were assayed for homocysteine by high performance liquid chromatography (HPLC). Myocardial necrosis was assessed by measurements of cardiac troponin T (cTnT) on admission and 12 h after admission (peak cTnT). The patients were studied by quintiles of homocysteine concentration.

RESULTS

There was a significant increase in peak cTnT in the 5th homocysteine quintile in MI (analysis of variance [ANOVA], p = 0.005), the levels being 4.10, 3.86, 4.13, 6.20 and 7.85 µg/liter for quintiles 1 to 5, respectively (p < 0.0001, for top vs. bottom quintile). Similarly, there was a step-up in peak cTnT levels in the top homocysteine quintile in UAP (ANOVA, p < 0.0001), the levels being 0.03, 0.03, 0.02, 0.04 and 0.15 µg/liter, (p < 0.0001 for top vs. bottom quintile). In a multivariate regression model, the association between peak cTnT and the top homocysteine quintile remained strong after adjustment of other confounders including age, gender, final diagnosis and thrombolysis treatment (odds ratio [OR]: 2.92 (1.75–4.87) p < 0.0001). The patients with UAP were further examined according to peak cTnT levels below (cTnT negative) or above (cTnT positive) 0.1 µg/liter. Homocysteine levels were significantly higher in cTnT positive than cTnT negative patients; 13.8 (11.7–15.3) vs. 10.3 (9.4–11.3) µmol/liter, respectively, p = 0.002.

CONCLUSIONS

Elevated homocysteine levels are associated with a higher risk of ischemic myocardial injury in patients presenting with ACS.

Abbreviations and Acronyms   ANOVA = analysis of variance   ACS = acute coronary syndromes   AST = aspartate transaminase   CI = confidence interval   CK = creatine kinase   cTnT = cardiac troponin T   ECG = electrocardiogram   ELISA = enzyme-linked immunoabsorbent assay   HBD = hydroxybutyrate dehydrogenase   MI = myocardial infarction   UAP = unstable angina pectoris   WHO = World Health Organization

This article has been cited by other articles:

				G. E. Luzardo, R. A. Karlnoski, B. Williams, D. Mangar, and E. M. Camporesi Anesthetic Management of a Parturient with Hyperhomocysteinemia Anesth. Analg., June 1, 2008; 106(6): 1833 - 1836. [Abstract] [Full Text] [PDF]

				S. Kaul, A. A. Zadeh, and P. K. Shah Homocysteine Hypothesis for Atherothrombotic Cardiovascular Disease: Not Validated J. Am. Coll. Cardiol., September 5, 2006; 48(5): 914 - 923. [Abstract] [Full Text] [PDF]

				U. Schwab, A. Torronen, E. Meririnne, M. Saarinen, G. Alfthan, A. Aro, and M. Uusitupa Orally Administered Betaine Has an Acute and Dose-Dependent Effect on Serum Betaine and Plasma Homocysteine Concentrations in Healthy Humans J. Nutr., January 1, 2006; 136(1): 34 - 38. [Abstract] [Full Text] [PDF]

				E. Bozkurt, S. Keles, M. Acikel, M. Islek, and S. Atesal Plasma Homocysteine Level and the Angiographic Extent of Coronary Artery Disease Angiology, May 1, 2004; 55(3): 265 - 270. [Abstract] [PDF]

				D. E. Zylberstein, C. Bengtsson, C. Bjorkelund, S. Landaas, V. Sundh, D. Thelle, and L. Lissner Serum Homocysteine in Relation to Mortality and Morbidity From Coronary Heart Disease: A 24-Year Follow-Up of the Population Study of Women in Gothenburg Circulation, February 10, 2004; 109(5): 601 - 606. [Abstract] [Full Text] [PDF]

				R. S. Vasan, A. Beiser, R. B. D'Agostino, D. Levy, J. Selhub, P. F. Jacques, I. H. Rosenberg, and P. W. F. Wilson Plasma Homocysteine and Risk for Congestive Heart Failure in Adults Without Prior Myocardial Infarction JAMA, March 12, 2003; 289(10): 1251 - 1257. [Abstract] [Full Text] [PDF]

				A. P. Burke, V. Fonseca, F. Kolodgie, A. Zieske, L. Fink, and R. Virmani Increased Serum Homocysteine and Sudden Death Resulting from Coronary Atherosclerosis With Fibrous Plaques Arterioscler. Thromb. Vasc. Biol., November 1, 2002; 22(11): 1936 - 1941. [Abstract] [Full Text] [PDF]

				Homocysteine Levels Predict Ischemic Injury in ACS Patients Journal Watch Cardiology, January 5, 2001; 2001(105): 7 - 7. [Full Text]