Prognostic value of homocysteinemia in patients with congestive heart failure
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Pierre Gibelin
Abstract
Background: Elevated plasma homocysteine levels are associated with increased risk of vascular disease and of congestive heart failure (CHF), with a relationship between homocysteine values and disease severity. Hyperhomocysteinemia is a risk factor for cardiac dysfunction. In this study, the predictive value of elevated homocysteine levels was investigated in the prognosis of ischemic and non-ischemic CHF.
Methods: A total of 159 patients with CHF, 89 with non-ischemic and 70 with ischemic CHF (83% males, mean age 62years, mean ejection fraction 27%), and 119 controls (79% males, mean age 59.8years) had fasting blood samples taken to measure plasma homocysteine, vitamin B12 and folate levels. Coronary angiography was performed for all patients. The mean duration of follow-up was 49.6±36.7months.
Results: As in other studies, the mean level of homocysteinemia was significantly higher in the CHF group (15.80μmol/L) than in the control group (10.90μmol/L) (p=0.001) whatever the etiology (non-ischemic, 16.11±6.84μmol/L; ischemic, 15.41±6.45μmol/L). This result was observed without vitamin deficiency, but in patients, the mean creatinine value was moderately higher than in controls. We found a positive correlation between plasma homocysteine levels and New York Heart Association (NYHA) classification, creatinine and age. Moreover, hyperhomocysteinemia appears to be a powerful predictive factor of mortality in CHF patients (relative risk of death, 4.23; p=0.0003). In the follow-up of this study, 41.5% of patients with homocysteinemia >17μmol/L died vs. 21.3% of patients with levels <17μmol/L. In multivariate analysis, when homocysteine levels were adjusted for a second parameter (age, NYHA, creatinine, diabetes), the risk of death remained significant after each adjustment.
Conclusions: Elevated homocysteine levels observed in CHF patients, whatever the etiology of their heart disease (ischemic or non-ischemic), were correlated with the severity of the disease. Hyperhomocysteinemia appears to be a predictive factor of mortality in CHF patients.
Clin Chem Lab Med 2006;44:813–6.
References
1. Kannel W. Incidence and epidemiology of heart failure. Heart Fail Rev 2000; 5:167–73.10.1023/A:1009884820941Search in Google Scholar
2. Roger V, Weston S, Redfield M, Hellermann-Homan J, Killian J, Yawn BP, et al. Trends in heart failure incidence and survival in a community-based population. J Am Med Assoc 2004; 292:344–50.10.1001/jama.292.3.344Search in Google Scholar
3. Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset S. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 1997; 337:230–6.10.1056/NEJM199707243370403Search in Google Scholar
4. Alfthan G, Aro A, Gey KF. Plasma homocysteine and cardiovascular disease mortality. Lancet 1997; 349:397.10.1016/S0140-6736(97)80014-1Search in Google Scholar
5. Wald N, Watt H, Law M, Weir D, McPartlin J, Scott J. Homocysteine and ischemic heart disease: results of a prospective study with implications regarding prevention. Arch Intern Med 1998; 158:862–7.10.1001/archinte.158.8.862Search in Google Scholar
6. Wald D, Law M, Morris J. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. Br Med J 2002; 325:1202–13.10.1136/bmj.325.7374.1202Search in Google Scholar
7. Blann AD. Endothelial cell damage and homocysteine. Atherosclerosis 1992; 94:89–91.10.1016/0021-9150(92)90192-JSearch in Google Scholar
8. Al-Shaer M, Raghuveer G, Browning R, Sinkey C, Chenard C, Stumbo P, et al. Effect of hyperhomocysteinemia induced by methionine administration on flow-mediated dilatation of the brachial artery in healthy subjects. Am J Cardiol 2005; 95:428–30.10.1016/j.amjcard.2004.09.052Search in Google Scholar PubMed
9. Kennedy R, Owings R, Shekhawat N, Joseph J. Acute negative inotropic effects of homocysteine are mediated via the endothelium. Am J Physiol Heart Circ Physiol 2004; 287:H812–7.10.1152/ajpheart.01042.2003Search in Google Scholar PubMed
10. Ventura P, Panini R, Verlato C, Scarpetta G, Salvioli G. Hyperhomocysteinemia and related factors in 600 hospitalized elderly subjects. Metabolism 2001; 50:1466–71.10.1053/meta.2001.28079Search in Google Scholar PubMed
11. Vasan R, Beiser A, D'Agostino R, Levy D, Selhub J, Jacques P, et al. Plasma homocysteine and risk for congestive heart failure in adults without prior myocardial infarction. J Am Med Assoc 2003; 289:1251–7.10.1001/jama.289.10.1251Search in Google Scholar PubMed
12. Sundstrom J, Vasan R. Homocysteine and heart failure: a review of investigations from the Framingham Heart Study. Clin Chem Lab Med 2005; 43:987–92.10.1515/CCLM.2005.173Search in Google Scholar PubMed
13. Sundstrom J, Sullivan L, Selhub J, Benjamin E, D'Agostino R, Jacques P, et al. Relations of plasma homocysteine to left ventricular structure function: Framingham Heart Study. Eur Heart J 2004; 25:523–30.10.1016/j.ehj.2004.01.008Search in Google Scholar PubMed
14. Herrmann M, Kindermann I, Müller S, Georg T, Kindermann M, Böhm M, et al. Relationship of plasma homocysteine with the severity of chronic heart failure. Clin Chem 2005; 10:1512–5.10.1373/clinchem.2005.049841Search in Google Scholar PubMed
15. Joseph J, Joseph L, Shekhawat N, Devi S, Wang J, Melchert R, et al. Hyperhomocysteinemia leads to pathological ventricular hypertrophy in normotensive rats. Am J Physiol Heart Circ Physiol 2003; 285:H679–86.10.1152/ajpheart.00145.2003Search in Google Scholar PubMed
16. Joseph J, Kennedy R, Devi S, Wang J, Joseph L, Hauer-Jensen M. Protective role of mast cells in homocysteine-induced cardiac remodeling. Am J Physiol Heart Circ Physiol 2005; 288:H2541–5.10.1152/ajpheart.00806.2004Search in Google Scholar PubMed
17. Norlund L, Grubb A, Fex G, Leskell H, Nilsson JE, Schenck H, et al. The increase of plasma homocysteine concentrations with age is partly due to the deterioration of renal function as determined by plasma cystatin C. Clin Chem Lab Med 1998; 36:175–8.10.1515/CCLM.1998.032Search in Google Scholar PubMed
18. Henning BF, Riezler R, Tepel M, Langer K, Raidt H, Graefe U, et al. Evidence of altered homocysteine metabolism in chronic renal failure. Nephron 1999; 83:314–22.10.1159/000045423Search in Google Scholar PubMed
19. Andersson S, Edvinsson M, Edvinsson L. Reduction of homocysteine in elderly with heart failure improved vascular function and blood pressure control but did not affect inflammatory activity. Basic Clin Pharmacol Toxicol 2005; 97:306–10.10.1111/j.1742-7843.2005.pto_146.xSearch in Google Scholar PubMed
©2006 by Walter de Gruyter Berlin New York
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- Recommendation to treat continuous variable errors like attribute errors
- Polymorphisms associated with apolipoprotein B levels in Greek patients with familial hypercholesterolemia
- Lack of association between α2B-adrenergic receptor polymorphism and risk of restenosis following coronary angioplasty and stent implantation – preliminary report
- Prognostic value of homocysteinemia in patients with congestive heart failure
- Comparability of indices for insulin resistance and insulin secretion determined during oral glucose tolerance tests
- Evaluation of clinical markers of atherosclerosis in young and elderly Japanese adults
- Hypoadiponectinemia is associated with symptomatic atherosclerotic peripheral arterial disease
- Cardiac troponin T and amino-terminal pro-natriuretic peptide concentrations in fetuses in the second trimester and in healthy neonates
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- Fluorimetric determination of activity and isoenzyme composition of N-acetyl-β-D-hexosaminidase in seminal plasma of fertile men and infertile patients with secretory azoospermia
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- Elevated plasma homocysteine levels in L-dopa-treated Parkinson's disease patients with dyskinesias
- Use of total patient data for indirect estimation of reference intervals for 40 clinical chemical analytes in Turkey
- Use of haemolysis index to estimate potassium concentration in in-vitro haemolysed serum samples
- Longitudinal changes in serum paraoxonase-1 activity throughout normal pregnancy
- Establishment of detailed reference values for luteinizing hormone, follicle stimulating hormone, estradiol, and progesterone during different phases of the menstrual cycle on the Abbott ARCHITECT® analyzer
- Evaluation and quality assessment of glucose concentration measurement in blood by point-of-care testing devices
- Hypothesis on interferences in kinetic interaction of microparticles in solution (KIMS) technology
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