[Show abstract][Hide abstract] ABSTRACT: To evaluate the prevalence of hyperhomocysteinaemia in diabetic patients with no diabetic retinopathy (no DR), with non-proliferative diabetic retinopathy (NPDR) and with proliferative diabetic retinopathy (PDR).
This prospective, case-control study, included 179 diabetic patients and 156 age-matched controls with no diabetes and no history of ocular disease, who were undergoing routine physical checkups. Plasma homocysteine levels of all study participants were measured using high-performance liquid chromatography (HPLC). Hyperhomocysteinaemia was defined when homocysteine levels were higher than 15 micromol/l.
The mean plasma homocysteine level was 11.75+-0.24 in the control group,13.46+0.74 in the no DR group, 14.56 + 0.64 in the NPDR group and 15.86 + 1.34 in the PDR group. Mean homocysteine levels were significantly elevated in the NPDR and PDR groups compared to the control group(P = 0.001 and <0.0001, respectively). The prevalence of hyperhomocysteinaemia was also higher in the NPDR and PDR groups compared to the control group (P = 0.032 and 0.011, respectively). No statistically significant difference was found between the no DR and the control group.
Our findings suggest that hyperhomocysteinaemia may be associated with diabetic retinopathy and partially explain the increased risk of microvascular angiopathy occurring in these patients.
[Show abstract][Hide abstract] ABSTRACT: To assess the relationship between plasma homocysteine levels and exudative neovascular age-related macular degeneration (AMD).
A prospective comparative cross-sectional study was conducted in outpatient ophthalmology clinics in a university-affiliated medical institution. The cohort consisted of 59 patients (25 male, 34 female) with a mean age of 78 years (standard deviation [SD] = 8.4) with neovascular AMD who were candidates for photodynamic treatment. Patients were compared for plasma homocysteine levels with 58 patients who had dry AMD (24 male, 34 female) with a mean age of 76.3 years (SD = 8.4) and with a control group of 56 age-matched subjects (27 male, 29 female), with a mean age of 77.3 years (SD = 8.2). A 3-ml venous blood sample was obtained from each participant after an 8-hour fast. Levels of plasma homocysteine were measured by high performance liquid chromatography. The main outcome measure was hyperhomocysteinemia, defined as a plasma homocysteine level above 15 micromol/l.
Homocysteine levels were higher by 27.9% in the neovascular AMD than in the dry AMD group, and by 21.9% than in the control group (P <.02). Hyperhomocysteinemia was found in 44.1% of the study group, in 22.4% of the dry AMD group, and in 21.4% of the control group (P =.011).
This study suggests an association between an elevated plasma level of homocysteine and exudative neovascular AMD but not dry AMD.
American Journal of Ophthalmology 01/2004; 137(1):84-9. · 4.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Elevated plasma homocysteine has been found to be a risk factor for Alzheimer's disease as well as cerebral vascular disease, suggesting that some risk factors can accelerate or increase the severity of several CNS disease processes. The authors measured plasma homocysteine levels in patients with chronic schizophrenia in their catchment area.
A one-way analysis of covariance with age and sex as covariates was performed on the total plasma homocysteine levels of 193 patients with schizophrenia compared with 762 subjects without the diagnosis of schizophrenia who were evaluated in a screening program for employee health.
The effect of schizophrenia was marked: the mean homocysteine level was 16.3 micro M (SD=11.8) in patients with schizophrenia compared with 10.6 micro M (SD=3.6) in healthy comparison subjects. The difference between groups was almost entirely attributable to the homocysteine levels of young male patients with schizophrenia.
Elevated levels of homocysteine in young male patients with schizophrenia could be related to the pathophysiology of aspects of this illness.
American Journal of Psychiatry 11/2002; 159(10):1790-2. · 13.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hyperhomocysteinemia is an independent risk factor for the development of atherosclerosis in adult patients on dialysis or after kidney transplantation. There are few data on homocysteine (Hcy) concentrations in children under these circumstances. The aim of our study was to evaluate plasma Hcy levels and their determining factors in children on renal replacement therapy. In 29 children and adolescents on chronic dialysis therapy and in 34 children after renal transplantation (Tx) fasting total plasma Hcy, red blood cell (RBC) folate, and serum vitamin B(12) levels were measured. The plasma Hcy levels were expressed as number of standard deviations (SD) from mean level in age- and gender-matched controls. In dialysis patients the mean plasma Hcy level was elevated (4.4+/-0.8 SDs), without significant difference between patients on hemodialysis or continuous cycling peritoneal dialysis. In the dialysis patients a negative correlation ( r=-0.49) between plasma Hcy levels and RBC folate concentrations was found. Oral folate supplementation was given to 8 of 21 dialysis patients, resulting in high RBC folate levels (>800 micro g/ml) and normalization of the plasma Hcy levels (0.4+/-0.5 SDs). In Tx patients the mean plasma Hcy level was 5.6+/-1.4 SDs. Multivariate regression analysis revealed that the main factor determining Hcy level after kidney Tx was creatinine clearance. Patients with normal kidney function had a mean Hcy concentration of 1.69+/-0.86 compared with 10.0+/-2.2 in children with decreased function. Folate and cyclosporine levels had less significant effects on Hcy concentrations. Seven patients who were evaluated while on dialysis and after a successful kidney Tx demonstrated a significant reduction in Hcy levels. Children and adolescents on dialysis therapy and with impaired renal function after renal Tx have significant hyperhomocysteinemia. Oral folate supplementation normalizes the increased plasma Hcy levels and should be added to the medical treatment of all children with impaired renal function.
[Show abstract][Hide abstract] ABSTRACT: Levels of homocysteine, methylmalonic acid, and relevant vitamins were measured and evaluated in patients with oral dysphagia (OD) receiving long-term care (LTC).
Group A was composed of 26 orally fed patients, and group B was composed of 25 patients who were fed by nasogastric tube. All patients were hospitalized in the LTC departments of the Geriatric Medical Center, Shmuel Harofe. General and nutritional status were assessed, and levels of vitamins including B12, folate, and B6 were measured along with serum homocysteine and urine methylmalonic acid levels.
Homocysteine levels were significantly higher in the orally fed patients (p < .001); 92% had higher-than-normal homocysteine levels. The levels of vitamins B12, folate, and B6 were significantly lower in the orally fed patients (p < .001), although in most patients levels were in the normal range. Notably, the levels of homocysteine were significantly correlated with the levels of all vitamins but not with the albumin or hemoglobin values. Levels of methylmalonic acid were also higher in the orally fed patients, but the difference was not statistically significant, and there was no correlation between vitamin level and methylmalonic acid level.
Orally fed patients with OD have substantially higher homocysteine levels and appreciably lower levels of the relevant vitamins than patients with OD who receive tube feeding. Therefore, homocysteine measurement may be the preferred indicator of vitamin intake in orally fed patients with OD.
Journal of Parenteral and Enteral Nutrition 03/2002; 26(2):94-7. · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine total serum homocysteine levels in a large group of patients with migraine with and without aura.
Hypercoagulable state is a known risk factor for stroke in the young. The existence of a hypercoagulable state has been postulated in migraine and homocysteinemia with young-onset stroke. To the best of our knowledge, blood homocysteine has not been studied in a significant number of patients with various forms of migraine.
Total serum homocysteine was measured with high-performance liquid chromatography in 78 patients with migraine and in 126 age- and sex-matched healthy volunteers.
Seventy-eight patients aged 18 to 65 years were studied: 22 with migraine with aura and 56 with migraine without aura. Only 1 man had significantly elevated blood homocysteine (38.6 micromol/L), while another had a borderline elevation (15.8 micromol/L) (reference value for both sexes in our laboratory is 4 to 14 micromol/L). Both patients suffered from migraine without aura.
Blood homocysteine is not elevated in migraine.
Headache The Journal of Head and Face Pain 10/2001; 41(8):779-81. · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Case-control and prospective studies indicate that an elevated plasma homocysteine level is a powerful risk factor for atherosclerotic vascular diseases. Certain medications can induce hyperhomocystinemia, such as methotrexate, trimethoprim and anti-epileptic drugs. There are few reports indicating an interaction between lipid-lowering drugs (cholestyramine and niacin) and homocysteine. Recently, an interaction was shown between fenofibrate and benzafibrates (a fibric acid derivative) and homocysteine plasma levels.
To evaluate the effects of different fibrates on plasma homocysteine levels and to measure the reversibility of this effect.
We investigated the effects of ciprofibrate and bezafibrate on homocysteine levels in patients with type IV hyperlipidemia and/or low high density lipoprotein levels. While a 57% increase in homocysteine was detected in the ciprofibrate-treated group (n = 26), a 17% reduction in homocysteine was detected in the group treated with bezafibrate (n = 12). The increase in homocysteine in the ciprofibrate-treated group was sustained for the 12 weeks of treatment and was partially reversible after 6 weeks of discontinuing the ciprofibrate therapy.
These results indicate that an increase in plasma homocysteine levels following administration of fibrates is not a class effect, at least in its magnitude. Moreover, it is reversible upon discontinuation of the treatment.
The Israel Medical Association journal: IMAJ 05/2001; 3(4):243-6. · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to describe the distribution of serum levels of total homocysteine (HCys) in a sample of older patients consecutively admitted following acute ischemic cerebral stroke, as compared with healthy controls, and to test for possible relationships of HCys levels to some of the prevalent cardiovascular diseases in these stroke patients. One hundred and thirty-seven stroke patients and 132 healthy controls (age > or =60) participated in this study. HCys levels were determined by HPLC method with fluorescence detection. Correlates of HCys levels and clinical data were examined. The results showed that stroke patients (mean age 74.6+/-9.2) had higher HCys levels as compared with controls (13.8 and 9.8 respectively, p<0.001). Advanced age, male gender, absence of diabetes and a positive history of previous myocardial infarction were the factors associated with HCys levels higher than 10 mmol/L (Odds ratio 2.72, 2.54, 3.12, 3.55, respectively). We conclude that hyperhomocysteinemia is prevalent in older patients with acute ischemic stroke. Few factors associated with increased risk for hyperhomocysteinemia in these stroke patients were identified. The study supports earlier observations regarding elevated HCys levels in stroke patients and increased prevalence of associated cardiovascular disease.