Regarding “High prevalence of mild hyperhomocysteinemia in patients with abdominal aortic aneurysm”
Article Outline
To the Editors:
We are writing in regard to your published article “High prevalence of mild hyperhomocysteinemia in patients with abdominal aortic aneurysm” (J Vasc Surg 2000;32:531-6). The purpose of the authors was to evaluate homocysteine and thrombomodulin plasma levels and the prevalence of C677 TMTHFR mutation in patients with abdominal aortic aneurysm (AAA). Hyperhomocysteinemia above 15.5 μmol/L was detected in 26 of 58 patients with AAA, and the authors suggest an association between the presence of AAA and hyperhomocysteinemia.
We also investigated homocysteine plasma levels in 648 patients selected for vascular surgery and 111 control subjects. Among the patients, 180 presented with cerebrovascular disease (CD), 343 with lower extremity occlusive disease (LED), and 125 with AAA. Total plasma homocysteine was analyzed by high performance liquid chromatography equipped with a fluorescence detector, with pre-column derivatization with ABD-F (Bio-Rad). In the control group the cutoff value was fixed at the 97.5th percentile (12.71 μmol/L for males and 12.22 μmol/L for females). Median homocysteine concentration was significantly higher in patients than in controls (18.10 μmol/L vs 8.71 μmol/L for men and 17.42 μmol/L vs 7.84 μmol/L for women). The prevalence of hyperhomocysteinemia, defined as homocysteine levels above the cutoff value, was 19.4% in patients with CD (35/180), 58.8% in patients with LED (202/343), but only 11.2% in patients with AAA (14/125).
Our findings do not support a strong association between mild hyperhomocysteinemia and AAA as indicated in the study by Brunelli et al, whereas a significant relationship was observed in subjects with LED. For this reason, we have started with a prospective study to elucidate the risk of progression of peripheral atherosclerosis in relation to plasma homocysteine levels.
24/41/116305
References
- High prevalence of mild hyperhomocysteinemia in patients with abdominal aortic aneurysm. J Vasc Surg. 2000;32:531–536
- . Homocysteinemia as risk factor for atherosclerosis: a review. Cardiovasc Surg. 1997;5:559–567
- . Prospective blinded study of the relationship between plasma homocysteine with progression of symptomatic peripheral arterial disease. J Vasc Surg. 1999;29:8–21
PII: S0741-5214(01)70073-0
© 2001 Mosby, Inc. All rights reserved.
