Cardiovascular manifestations of intermediate and major hyperhomocysteinemia due to vitamin B12 and folate deficiency and/or inherited disorders of one-carbon metabolism: a 3.5-year retrospective cross-sectional study of consecutive patients
| Autor: | Elise Jeannesson, Julien Levy, Stéphane Ziuly, Rosa-Maria Rodriguez-Guéant, Jean-Louis Guéant, Abderrahim Oussalah, Denis Wahl |
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| Přispěvatelé: | Biochimie – Biologie moléculaire et Nutrition [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), This study was funded by FHU ARRIMAGE and the French Agence Nationale de la Recherche, PIA project, Lorraine Université d’Excellence, reference ANR-15-IDEX-04-LUE., IMPACT GEENAGE, ANR-15-IDEX-0004,LUE,Isite LUE(2015) |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male 0301 basic medicine Vitamin medicine.medical_specialty Hyperhomocysteinemia Homocysteine Cross-sectional study [SDV]Life Sciences [q-bio] Methylmalonic acid Medicine (miscellaneous) thromboembolic manifestations inborn errors of metabolism Folic Acid Deficiency 030204 cardiovascular system & hematology folate Gastroenterology 03 medical and health sciences chemistry.chemical_compound Folic Acid 0302 clinical medicine Internal medicine medicine Humans Vitamin B12 Retrospective Studies 2. Zero hunger Nutrition and Dietetics business.industry Genetic disorder homocysteine vitamin B12 Middle Aged medicine.disease cardiovascular disease risk 3. Good health Vitamin B 12 Malnutrition Cross-Sectional Studies 030104 developmental biology chemistry Cardiovascular Diseases Child Preschool 1-carbon metabolism Female business Metabolism Inborn Errors Methylmalonic Acid |
| Zdroj: | American Journal of Clinical Nutrition American Journal of Clinical Nutrition, American Society for Nutrition, 2021, 113 (5), pp.1157-1167. ⟨10.1093/ajcn/nqaa432⟩ |
| ISSN: | 0002-9165 |
| DOI: | 10.1093/ajcn/nqaa432 |
| Popis: | International audience; ABSTRACT Background The association of moderate hyperhomocysteinemia (HHcy) (15–30 μmol/L) with cardiovascular diseases (CVD) has been challenged by the lack of benefit of vitamin supplementation to lowering homocysteine. Consequently, the results of interventional studies have confused the debate regarding the management of patients with intermediate/severe HHcy. Objective We sought to evaluate the association of intermediate (30–100 μmol/L) and severe (>100 μmol/L) HHcy related to vitamin deficiencies and/or inherited disorders with CVD outcomes. Methods We performed a retrospective cross-sectional study on consecutive patients who underwent a homocysteine assay in a French University Regional Hospital Center. Patients with CVD outcomes were assessed for vitamin B12, folate, Hcy, methylmalonic acid, and next-generation clinical exome sequencing. Results We evaluated 165 patients hospitalized for thromboembolic and other cardiovascular (CV) manifestations among 1006 patients consecutively recruited. Among them, 84% (138/165) had Hcy >30 μmol/L, 27% Hcy >50 μmol/L (44/165) and 3% Hcy >100 μmol/L (5/165). HHcy was related to vitamin B12 and/or folate deficiency in 55% (87/165), mutations in one or more genes of one-carbon and/or vitamin B12 metabolisms in 11% (19/165), and severe renal failure in 15% (21/141) of the studied patients. HHcy was the single vascular risk retrieved in almost 9% (15/165) of patients. Sixty % (101/165) of patients received a supplementation to treat HHcy, with a significant decrease in median Hcy from 41 to 17 µmol/L (IQR: 33.6–60.4 compared with 12.1–28). No recurrence of thromboembolic manifestations was observed after supplementation and antithrombotic treatment of patients who had HHcy as a single risk, after ∼4 y of follow-up. Conclusion The high frequency of intermediate/severe HHcy differs from the frequent moderate HHcy reported in previous observational studies of patients with pre-existing CVD. Our study points out the importance of diagnosing and treating nutritional deficiencies and inherited disorders to reverse intermediate/severe HHcy associated with CVD outcomes. |
| Databáze: | OpenAIRE |
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