Homocysteine/Coronary Atherosclerosis and Cardiac Transplantation: A Case Control Study

Summary

Background Hyperhomocysteinemia has been implicated as an independent risk factor for atherosclerotic cardiovascular disease. Both cardiac transplantation and diabetes are associated with accelerated coronary artery disease. We therefore, designed this study to determine serum homocysteine levels in cardiac transplant recipients and patients with diabetes. We also sought to determine the relationship between hyperhomocysteinemia and renal insufficiency and its response to oral supplementation with folic acid.

Methods We measured fasting serum creatinine and homocysteine levels in 34 cardiac transplant patients, 29 patients with diabetes and 36 heart failure patients who served as controls.

Results Mean serum creatinine was significantly elevated in the heart transplant group (1.8 ± 0.5mg/dl, p < 0.01) and diabetes group (1.6 ± 0.8mg/dl, 0.02) as compared to the control group. The mean serum homocysteine level was also significantly elevated in the heart transplant group (18.1 ± 6microM/l, p < 0.001) as well as diabetic group (17.1 ± 8microM/L, p < 0.002) as compared to the control group (11.6 ± 5 microM/L). There was a strong correlation between the serum homocysteine level and the serum creatinine in the heart transplant group (r = 0.5, p < 0.002), diabetes group (r = 0.8, p < 0.002) as well as control group (r = 0.8, p < 0.03). However, there was a weak relationship between serum homocysteine and time since heart transplant (r = 0.11, p = 0.5). Heart transplant patients and patients in the diabetes group were treated with 1000 micrograms of oral folic acid for at least 4 weeks. There was no significant change in the homocysteine levels after the treatment.

Conclusions Hyperhomocysteinemia is common among heart transplant recipients and diabetic patients. The serum homocysteine level correlates well with the degree of renal insufficiency.