Hyperhomocysteinemia and increased risk of coronary artery disease in Iranian patients with diabetes mellitus type II: a cross-sectional study

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Hyperhomocysteinemia in patients with diabetes mellitus (DM) has been proposed as a new risk factor for coronary artery disease (CAD). Due to the prevalence of DM and CAD in the Iranian population and the relatively high economic burden, research on these new risk factors sounds necessary. This study investigated the relationship between hyperhomocysteinemia and coronary heart disease in patients with type 2 diabetes. This study was a hospital-based cross-sectional study performed on 100 diabetic patients with indications of coronary artery angiography. After the measurement of serum HbA1c and homocysteine, the patients went through coronary angiography and, based on the results, were divided into two groups of normal and obstructed coronary arteries. Serum homocysteine and other related risk factors were further compared between the two groups. The mean serum homocysteine of patients was 13.18 ± 3.64 μmol/L in general and 15.02 ± 3.7 μmol/L in those with coronary artery obstruction. With hyperhomocysteinemia defined as serum homocysteine of ≥ 14 μmol/L, 48% of diabetic patients had hyperhomocysteinemia, of which 83% had coronary artery obstruction. The relationship between serum homocysteine and coronary artery obstruction was significant (P < 0.001). The serum homocysteine was the highest in patients with three-vessel involvement (15.39 ± 3.5 μmol/L), which was significantly higher than those with normal coronary arteries (P < 0.001). The mean serum homocysteine of diabetic patients (type II) with coronary artery disease was significantly higher than those with normal coronary arteries. It was also significantly higher in patients with three-vessel involvement than those with no vessel involvement.

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The researcher wishes to express his appreciation to the full cooperation of the patients and personnel who participated in this study and the Clinical Research Center of Shahid Mostafa Khomeini Hospital.

Availability of data and materials

The dataset used in this study is available with the authors and can be made available upon request.


The financial support for the current research was provided by Research Deputy of Shahed University of Medical Sciences, Tehran, Iran.

Author information

All the authors participated in the study design. Mohammad Reza Rajabi and Mohammad Reza Razzaghof collected and documented the data and assisted in preliminary data analysis. Mohammad Reza Rajabi wrote the initial draft. Mohammad Reza Rajabi and Hamed Haddad Kashani in draft revision, data analysis, and editing of the final draft.

Correspondence to Mohammad Reza Razzaghof.

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Conflict of interests

The authors declare that they have no competing interests.

Informed consent

Informed consent or a substitute for it was obtained from all patients included in the study.

Ethics approval and consent to participate

This study was approved be Shahed University of Medical Sciences under the grant number of 16/35/10/3560 in 14 July 2015. The informed consent form was signed by all parents. All procedures involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and ethical standards of the institutional and national research committee of Shahed University of Medical Sciences and obtained ethics committee permission number of SHUM.REG.1393.136.

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Rajabi, M.R., Razzaghof, M.R. & Haddad Kashani, H. Hyperhomocysteinemia and increased risk of coronary artery disease in Iranian patients with diabetes mellitus type II: a cross-sectional study. Comp Clin Pathol 29, 223–230 (2020) doi:10.1007/s00580-019-03027-5

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  • Hyperhomocysteinemia
  • Diabetes mellitus type II
  • Coronary artery disease
  • Coronary atherosclerosis