The Impact of Metabolic Syndrome, Homocysteine, and B Vitamins on Carotid Artery Intima-Media Thickness in Hypertensive Patients.

OBJECTIVES: To examine the correlation between metabolic syndrome (MS), plasma total homocysteine (tHcy) level, and serum B vitamin levels on carotid intima-media thickness (CIMT) in hypertensive patients. METHODS: A total of 73 medically treated hypertensive patients (42 men, mean age 70.7 years), fasted for 10 hours, and provided fasting blood samples for measurement of plasma tHcy, serum folic acid, and serum vitamin B12 levels. Additionally, B-mode ultrasound of the distal right common carotid arteries was performed on all participants. RESULTS: There were 50 patients with and 23 patients without MS. Patients with MS had larger CIMT than patient without (0.81 ± 0.13 vs. 0.74 ± 0.10 mm, p = 0.018). Patients with MS had larger waist circumference (p < 0.001), higher body mass index (p < 0.001), elevated serum triglyceride level (p < 0.001), lower serum high density lipoprotein level (p = 0.016), higher prevalence of diabetes mellitus (p = 0.012), higher prevalence of hyperlipidemia (p = 0.019), and a higher prevalence of fibrate usage (p = 0.025) than patients without MS. In univariate analysis, CIMT correlated significantly with the presence of MS (r = 0.256; p = 0.029), usage of angiotensin receptor blocker (ARB; r = -0.256; p = 0.029), and male gender (r = 0.247; p = 0.035). The relationships between CIMT and serum folic acid level (r = -0.212; p = 0.072) or statin usage (r = 0.207; p = 0.079) were borderline significant. In multivariate regression analysis, after adjusting for age and gender, only usage of ARB (ß value -0.078, 95% CI: -0.140 to -0.015, p = 0.016) and the presence of MS (ß value 0.075, 95% CI: 0.020 to 0.131, p = 0.009) were associated with CIMT. In anothermodel, after adjusting four additional parameters including age, gender, systolic blood pressure and usage of statin, usage of ARB (ß value -0.074, 95% CI: -0.137 to -0.011, p = 0.022) and presence of MS (ß value 0.069, 95% CI: 0.012 to 0.125, p = 0.017) remained significantly correlated with CIMT. CONCLUSION: MS and usage of ARB are associated with CIMT in hypertensive patients. KEY WORDS: Folic acid; Homocysteine, Intima-media thickness, Metabolic syndrome.

Waist-to-hip ratio correlates with homocysteine levels in male patients with coronary artery disease.

BACKGROUND: Obesity and homocysteine are important risk factors for cardiovascular disease. The relation between pattern of obesity and homocysteine is unclear. The objective of this study was to investigate the relation between pattern of obesity and plasma total homocysteine (tHcy) level in male patients with coronary artery disease (CAD). METHODS: A total of 63 male patients (mean age 66.2 years) with angiographically documented CAD were enrolled. Overnight fasting blood samples were measured for plasma tHcy, serum folic acid and serum vitamin B12 levels. Anthropometric measurements included waist-to-hip ratio (WHR) and body mass index (BMI). RESULTS: The mean WHR was 0.90+/-0.05, mean BMI 24.6+/-3.3 kg/m2 and the mean plasma tHcy level 11.6+/-3.2 micromol/L. In univariate analysis, plasma tHcy level correlated significantly with serum vitamin B12 level, serum folic acid level, WHR, estimated creatinine clearance, aspirin use and fibrate use. There was no significant association between plasma tHcy level and BMI. In multivariate analysis, only WHR (beta-value 22.263, p<0.001), serum level of vitamin B12 (beta-value -0.004, p=0.003), estimated creatinine clearance (beta-value -4.154, p=0.003) and use of fibrates (beta-value 2.307, p=0.031) were independent predictors of plasma tHcy level. CONCLUSIONS: WHR, but not BMI, is a strong independent predictor of plasma tHcy level in male patients with CAD.

The influence of estimated creatinine clearance on plasma homocysteine in hypertensive patients with normal serum creatinine.

OBJECTIVES: To examine the relation of estimated creatinine clearance (eCrCl) and plasma total homocysteine (tHcy) in hypertensive patients with a normal serum creatinine level. DESIGN AND METHODS: A total of 137 hypertensive patients (mean age 66.6 years, 69 men) with serum creatinine level 60 mL/min/1.73 m(2)). The CRI group was older (p<0.001), had higher tHcy (p<0.001), higher serum urea nitrogen (p<0.001), higher serum creatinine (p<0.001), lower eCrCl (p<0.001), and lower diastolic blood pressure (p=0.001). In univariate analysis, eCrCl had the strongest correlation with tHcy (r=-0.453, p<0.001). Significant correlations, ranging in decreasing order from r=-0.418, p<0.001 to r=-0.170, p=0.047, were also noted between tHcy and twelve other variables. In multivariate analysis, only eCrCl (p<0.001), usage of fibrate (p<0.001), serum level of vitamin B(12) (p=0.002), serum level of folic acid (p=0.009), and smoking (p=0.027) were independent predictors of tHcy. CONCLUSION: eCrCl is a strong independent predictor of tHcy in hypertensive patients with normal serum creatinine.