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Homocysteine and Vascular Disease pp 217–238Cite as

Homocysteine as a Risk Factor for Cardiovascular Disease in Women

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Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 230))

Summary

Elevated plasma levels of total homocysteine are considered a risk factor for cardiovascular disease (CVD). Levels are generally lower in women than men, and in premenopausal than postmenopausal women. Differences in circulating estrogens may be partly responsible for these observations.

The present chapter reviews studies that have investigated associations of homocysteine with risk of CVD by gender or by menopausal status. Furthermore, the evidence for a homocysteine-lowering effect of estrogen replacement therapy in postmenopausal women is discussed.

Six out of 10 of the epidemiologic studies that included both men and women found elevated homocysteine to be a stronger risk factor in women than in men. Several of these studies estimated that the risk was about twice as high in women as in men. Three studies observed no effect modification, and one a weaker effect in women. Two studies that consisted (almost) entirely of women observed a direct association of elevated homocysteine with CVD risk as well, comparable to effects in male populations.

The stronger effect among women in some studies may be explained by aspects of the study design, such as young age at inclusion, or aspects of the data-analysis, such as use of an overall instead of a gender-specific cutoff-point. Also, one cannot exclude the possibility that women are somehow more susceptible to detrimental effects of homocysteine than men, although there is clear evidence from other studies that estrogens have a “protective” effect on the vascular wall and favorable effect on hemostasis.

Elevation of homocysteine is found to be a risk factor in populations of both young and elderly women, but only few studies have compared the relation between homocysteine and risk of CVD among premenopausal and postmenopausal women. Generally, it appears that women are not protected against CVD before the menopause. Several, mostly uncontrolled, intervention studies have indicated that estrogen replacement therapy, either alone, sequentially or continuously combined with progestogen, lowers homocysteine by about 11–13% during postmenopausal years.

In conclusion, we should consider elevated homocysteine as an equally strong, potential risk factor for CVD in both men and women, before and after the menopause. Results from randomized trials of B-vitamins, that are currently being conducted among large populations of men and women, will tell us whether homocysteine-lowering gives a CVD benefit.

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Authors
  1. Petra Verhoef
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Editors and Affiliations

  1. Department of Cardiology, The Cleveland Clinic Foundation, Desk F15, 9500 Euclid Avenue, 44195, Cleveland, Ohio, USA

    Killian Robinson

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© 2000 Springer Science+Business Media Dordrecht

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Verhoef, P. (2000). Homocysteine as a Risk Factor for Cardiovascular Disease in Women. In: Robinson, K. (eds) Homocysteine and Vascular Disease. Developments in Cardiovascular Medicine, vol 230. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-1789-2_13

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  • DOI: https://doi.org/10.1007/978-94-017-1789-2_13

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-5431-9

  • Online ISBN: 978-94-017-1789-2

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