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Clinical usefulness of plasma homocysteine in vascular disease

Graeme J Hankey, John W Eikelboom, Wai Khoon Ho and Frank M van Bockxmeer
Med J Aust 2004; 181 (6): 314-318.

Summary

  • Raised plasma homocysteine (tHcy) concentrations are caused by genetic mutations, vitamin deficiencies, renal and other diseases, numerous drugs, and increasing age.

  • Raised tHcy concentrations are associated with laboratory evidence of atherogenesis (eg, endothelial dysfunction) and thrombosis, and epidemiological evidence of an increased risk of atherothrombotic vascular disease.

  • An association between raised tHcy concentration and an increased risk of atherothrombosis is independent of other vascular risk factors, strong, dose-related and biologically plausible, but has not been proven to be causal in randomised controlled trials.

  • A recent trial identified no significant benefit from lowering tHcy concentration by folic-acid-based multivitamin therapy among 3680 patients with recent ischaemic stroke, but did not reliably exclude a modest but important reduction in the relative risk of stroke of up to 20%; a difference of only 2 mmol/L in tHcy concentration between the two treatment groups was probably due to widespread vitamin use and fortification of grains and staple foods with folate in North America.

  • There is currently insufficient evidence to recommend routine screening and treatment of high tHcy concentrations with folic acid and other vitamins to prevent atherothrombotic vascular disease.

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  • Graeme J Hankey1
  • John W Eikelboom2
  • Wai Khoon Ho3
  • Frank M van Bockxmeer4

  • Royal Perth Hospital, Perth, WA.

Correspondence: 

Competing interests:

None identified.

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