Circulation. 1998;98:196-199
(Circulation. 1998;98:196-199.)
© 1998 American Heart Association, Inc.
Homocysteine, Vitamins, and Cardiovascular Disease
Lewis H. Kuller, MD, DrPH;
; Rhobert W. Evans, PhD
From the University of Pittsburgh, Department of Epidemiology,
Pittsburgh, Pa.
Key Words: Editorials • cardiovascular diseases • homocysteine
The significance of
any association between cardiovascular disease and
circulating homocysteine concentrations is attracting considerable
attention. The normal activities of the transsulfuration and
remethylation pathways maintain intracellular homocysteine levels
within a narrow range, and the controlled release of homocysteine into
blood results in blood measurements that provide an accurate index of
homocysteine status. In the circulation, homocysteine is rapidly
oxidized, and very little homocysteine remains in the reduced form. The
majority of homocysteine forms a disulfide bridge with protein, and
some reacts either with itself to produce homocystine or with cysteine
to form the mixed disulfide
cysteine-homocysteine.1 Most analytical
procedures include a reduction step and do not distinguish between the
reduced and various oxidized forms of homocysteine; thus, the analyte
measured is referred to as homocyst(e)ine. The normal range is unclear
but may fall between 5 and 15 µmol/L.
Analyses of homocysteine usually involve fasting samples
of either serum or plasma. The concentrations are higher in serum, and
increases of 
10% have been reported in the postprandial
stage.2 Homocysteine levels also increase with
age and are higher in men than in women. A variety of disease states
and medications modify homocysteine concentrations, and notably,
impaired renal function may greatly increase homocysteine
levels.3 Measurement of homocysteine should avoid
blood samples that have been stored at room temperature, because red
blood cells may release homocysteine, causing an artifactual increase
in extracellular homocysteine concentrations.
A complicating aspect of homocysteine metabolism for
cardiovascular studies is that homocysteine
concentrations may increase after a myocardial infarction . . . [Full Text of this Article]
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