(Circulation. 1996;94:2743-2748.)
© 1996 American Heart Association, Inc.
Articles |
Hyperhomocysteinemia Confers an Independent Increased Risk of Atherosclerosis in End-Stage Renal Disease and Is Closely Linked to Plasma Folate and Pyridoxine Concentrations
the Departments of Cardiology (K.R., E.L.M.), Internal Medicine (A.G., P.V., D.C.), Nephrology and Hypertension (V.D.), Biostatistics and Epidemiology (K.A., M.K.), Clinical Pathology (R.G.), and Cell Biology (D.W.J.), the Cleveland (Ohio) Clinic Foundation, and the United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Mass (J.S.).
Correspondence to Killian Robinson, MD, Desk F15, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail robinsk@ccsmtp.ccf.org.
Background A high level of total plasma homocysteine is a risk factor for atherosclerosis, which is an important cause of death in renal failure. We evaluated the role of this as a risk factor for vascular complications of end-stage renal disease.
Methods and Results Total fasting plasma homocysteine and other risk factors were documented in 176 dialysis patients (97 men, 79 women; mean age, 56.3±14.8 years). Folate, vitamin B12, and pyridoxal phosphate concentrations were also determined. The prevalence of high total homocysteine values was determined by comparison with a normal reference population, and the risk of associated vascular complications was estimated by multiple logistic regression. Total homocysteine concentration was higher in patients than in the normal population (26.6±1.5 versus 10.1±1.7 µmol/L; P<.01). Abnormally high concentrations (>95th percentile for control subjects, 16.3 µmol/L) were seen in 149 patients (85%) with end-stage renal disease (P<.001). Patients with a homocysteine concentration in the upper two quintiles (>27.8 µmol/L) had an independent odds ratio of 2.9 (CI, 1.4 to 5.8; P=.007) of vascular complications. B vitamin levels were lower in patients with vascular complications than in those without. Vitamin B6 deficiency was more frequent in patients than in the normal reference population (18% versus 2%; P<.01).
Conclusions A high total plasma homocysteine concentration is an independent risk factor for atherosclerotic complications of end-stage renal disease. Such patients may benefit from higher doses of B vitamins than those currently recommended.
Key Words: risk factors • coronary disease • kidney
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