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1 From the LOCUS for Homocysteine and Related Vitamins, Armauer Hansens hus, University of Bergen, Bergen, Norway, and the Department of Epidemiology, University of Washington, Seattle.
ABSTRACT
Elevated plasma total homocysteine (tHcy) is a risk factor for occlusive cardiovascular disease (CVD). This concept is based on the observations of premature vascular disease in patients with homocystinuria, the relation between tHcy and both clinical CVD as well as preclinical atherosclerotic disease, the relation between tHcy in children and CVD in their parents or relatives, and reduction in CVD or surrogate endpoints after tHcy-lowering intervention with B vitamins. Plausible mechanisms include the in vivo interference with nitric oxidedependent reactive vasodilatation. Some observations have raised questions about tHcy as a risk factor. 1) Some prospective studies showed a weak relation or no relation between tHcy and CVD. 2) Several traditional risk factors are associated with tHcy and may confound the relation between tHcy and CVD. 3) tHcy is related to renal function, and hyperhomocysteinemia may reflect early nephrosclerosis. 4) The C677T transition of the methylenetetrahydrofolate reductase gene causes a moderate increase in tHcy but no or only minor increased CVD risk. However, the strength of some of these arguments can be questioned because there is increasing evidence that tHcy is a proximate risk factor provoking the acute event, it strongly interacts with traditional risk factors, and it may predict CVD or death in patients with chronic renal failure. Furthermore, the studies of the C677T polymorphism lack statistical power, and the TT genotype may even modulate CVD risk independently of homocysteine. Thus, only placebo-controlled intervention studies with tHcy-lowering B vitamins and clinical endpoints can provide additional valid arguments for the debate over whether tHcy is a causal CVD risk factor.
Key Words: Homocysteine cardiovascular disease methylenetetrahydrofolate reductase polymorphism renal nephrosclerosis
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A. G. Bostom, J. Selhub, P. F. Jacques, and I. H. Rosenberg Power Shortage: Clinical Trials Testing the "Homocysteine Hypothesis" against a Background of Folic Acid-Fortified Cereal Grain Flour Ann Intern Med, July 17, 2001; 135(2): 133 - 137. [Abstract] [Full Text] [PDF] |
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S. E. Vollset, H. Refsum, A. Tverdal, O. Nygard, J. E. Nordrehaug, G. S Tell, and P. M. Ueland Plasma total homocysteine and cardiovascular and noncardiovascular mortality: the Hordaland Homocysteine Study Am. J. Clinical Nutrition, July 1, 2001; 74(1): 130 - 136. [Abstract] [Full Text] [PDF] |
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J. L. Mills and L. England Food Fortification to Prevent Neural Tube Defects: Is It Working? JAMA, June 20, 2001; 285(23): 3022 - 3023. [Full Text] [PDF] |
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S. Friso, P. F. Jacques, P. W.F. Wilson, I. H. Rosenberg, and J. Selhub Low Circulating Vitamin B6 Is Associated With Elevation of the Inflammation Marker C-Reactive Protein Independently of Plasma Homocysteine Levels Circulation, June 12, 2001; 103(23): 2788 - 2791. [Abstract] [Full Text] [PDF] |
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G. Liaugaudas, P. F. Jacques, J. Selhub, I. H. Rosenberg, and A. G. Bostom Renal Insufficiency, Vitamin B12 Status, and Population Attributable Risk for Mild Hyperhomocysteinemia Among Coronary Artery Disease Patients in the Era of Folic Acid-Fortified Cereal Grain Flour Arterioscler. Thromb. Vasc. Biol., May 1, 2001; 21(5): 849 - 851. [Abstract] [Full Text] [PDF] |
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S. E. Vollset, H. Refsum, and P. M. Ueland Population determinants of homocysteine Am. J. Clinical Nutrition, March 1, 2001; 73(3): 499 - 500. [Full Text] [PDF] |
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R. Clarke Prevention of vitamin B-12 deficiency in old age Am. J. Clinical Nutrition, February 1, 2001; 73(2): 151 - 152. [Full Text] [PDF] |
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J. M Scott Homocysteine and cardiovascular risk Am. J. Clinical Nutrition, August 1, 2000; 72(2): 333 - 334. [Full Text] [PDF] |
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S. Friso, S.-W. Choi, D. Girelli, J. B. Mason, G. G. Dolnikowski, P. J. Bagley, O. Olivieri, P. F. Jacques, I. H. Rosenberg, R. Corrocher, et al. A common mutation in the 5,10-methylenetetrahydrofolate reductase gene affects genomic DNA methylation through an interaction with folate status PNAS, April 16, 2002; 99(8): 5606 - 5611. [Abstract] [Full Text] [PDF] |
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N. Weiss, Y.-Y. Zhang, S. Heydrick, C. Bierl, and J. Loscalzo Overexpression of cellular glutathione peroxidase rescues homocyst(e)ine-induced endothelial dysfunction PNAS, October 23, 2001; 98(22): 12503 - 12508. [Abstract] [Full Text] [PDF] |
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