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American Journal of Clinical Nutrition, Vol. 72, No. 2, 324-332, August 2000
© 2000 American Society for Clinical Nutrition


Perspectives

The controversy over homocysteine and cardiovascular risk1,2

Per M Ueland, Helga Refsum, Shirley AA Beresford and Stein Emil Vollset

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 oxide–dependent 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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CirculationHome page
J. W. Auer, R. Berent, B. Eber, S. Friso, P. F. Jacques, I. H. Rosenberg, J. Selhub, and P. W.F. Wilson
Lack of Association of Increased C-Reactive Protein and Total Plasma Homocysteine Response
Circulation, December 18, 2001; 104 (25): e164 - e164.
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J. Biol. Chem.Home page
S. Sengupta, C. Wehbe, A. K. Majors, M. E. Ketterer, P. M. DiBello, and D. W. Jacobsen
Relative Roles of Albumin and Ceruloplasmin in the Formation of Homocystine, Homocysteine-Cysteine-mixed Disulfide, and Cystine in Circulation
J. Biol. Chem., December 7, 2001; 276(50): 46896 - 46904.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
D. M Kerins, M. J Koury, A. Capdevila, S. Rana, and C. Wagner
Plasma S-adenosylhomocysteine is a more sensitive indicator of cardiovascular disease than plasma homocysteine
Am. J. Clinical Nutrition, December 1, 2001; 74(6): 723 - 729.
[Abstract] [Full Text]


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Arterioscler. Thromb. Vasc. Bio.Home page
S. Yap, G. H.J. Boers, B. Wilcken, D. E.L. Wilcken, D. P. Brenton, P. J. Lee, J. H. Walter, P. M. Howard, and E. R. Naughten
Vascular Outcome in Patients With Homocystinuria due to Cystathionine {beta}-Synthase Deficiency Treated Chronically: A Multicenter Observational Study
Arterioscler. Thromb. Vasc. Biol., December 1, 2001; 21(12): 2080 - 2085.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Endocrinol. Metab.Home page
G. J. Cuskelly, P. W. Stacpoole, J. Williamson, T. G. Baumgartner, and J. F. Gregory III
Deficiencies of folate and vitamin B6 exert distinct effects on homocysteine, serine, and methionine kinetics
Am J Physiol Endocrinol Metab, December 1, 2001; 281(6): E1182 - E1190.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Cattaneo, R. Lombardi, A. Lecchi, P. Bucciarelli, and P. M. Mannucci
Low Plasma Levels of Vitamin B6 Are Independently Associated With a Heightened Risk of Deep-Vein Thrombosis
Circulation, November 13, 2001; 104(20): 2442 - 2446.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
A. Ulvik and P. M. Ueland
Single Nucleotide Polymorphism (SNP) Genotyping in Unprocessed Whole Blood and Serum by Real-Time PCR: Application to SNPs Affecting Homocysteine and Folate Metabolism
Clin. Chem., November 1, 2001; 47(11): 2050 - 2053.
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J. Nutr.Home page
M. A. Caudill, J. C. Wang, S. Melnyk, I. P. Pogribny, S. Jernigan, M. D. Collins, J. Santos-Guzman, M. E. Swendseid, E. A. Cogger, and S. J. James
Intracellular S-Adenosylhomocysteine Concentrations Predict Global DNA Hypomethylation in Tissues of Methyl-Deficient Cystathionine {beta}-Synthase Heterozygous Mice
J. Nutr., November 1, 2001; 131(11): 2811 - 2818.
[Abstract] [Full Text] [PDF]


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J. Nutr.Home page
H. Jakubowski
Translational Accuracy of Aminoacyl-tRNA Synthetases: Implications for Atherosclerosis
J. Nutr., November 1, 2001; 131(11): 2983S - 2987.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
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 12, 2001; (2001) 231428998.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
A. Voortman, A. Melse-Boonstra, J. M. Schulz, J. Burema, M. B. Katan, and P. Verhoef
Optimal Time Interval between Repeated Blood Sampling for Measurements of Total Homocysteine in Healthy Individuals
Clin. Chem., October 1, 2001; 47(10): 1839 - 1841.
[Full Text] [PDF]


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ANN INTERN MEDHome page
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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Am. J. Clin. Nutr.Home page
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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JAMAHome page
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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CirculationHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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Am. J. Clin. Nutr.Home page
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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Am. J. Clin. Nutr.Home page
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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Am. J. Clin. Nutr.Home page
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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Proc. Natl. Acad. Sci. USAHome page
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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Proc. Natl. Acad. Sci. USAHome page
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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