1
|
Homocysteine as a Predictor of Paroxysmal Atrial Fibrillation-Related Events: A Scoping Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12092192. [PMID: 36140593 PMCID: PMC9498051 DOI: 10.3390/diagnostics12092192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 12/06/2022] Open
Abstract
High levels of homocysteine (Hcy) have been linked with adverse cardiovascular outcomes, such as arrhythmias and stroke. In the context of paroxysmal atrial fibrillation (PAF), hyperhomocysteinemia has been demonstrated to be an independent predictor of future events. The aim of this report was to address the potential value of Hcy levels in predicting future paroxysms of atrial fibrillation (AF), as well as to identify the potential mechanisms of action. We searched PubMed and the Cochrane Database on 16 January 2022. Keywords used were homocysteine or hyperhomocysteinemia paired with a total of 67 different keywords or phrases that have been implicated with the pathogenesis of AF. We included primary reports of clinical and non-clinical data in the English language, as well as systematic reviews with or without meta-analyses. We placed no time constraints on our search strategy, which yielded 3748 results. Following title review, 3293 reports were excluded and 455 reports were used for title and abstract review, after which 109 reports were finally used for full-text review. Our review indicates that Hcy levels seem to hold a predictive value in PAF. Herein, potential mechanisms of action are presented and special considerations are made for clinically relevant diagnostic procedures that could complement plasma levels in the prediction of future PAF events. Finally, gaps of evidence are identified and considerations for future clinical trial design are presented.
Collapse
|
2
|
Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Meta-analysis. TH OPEN 2021; 5:e420-e437. [PMID: 34595387 PMCID: PMC8463136 DOI: 10.1055/s-0041-1735978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Previous studies suggest an association between increased homocysteine (Hcy) and risk of ischemic stroke. Yet, it remains unknown whether a dose-response association exists between Hcy levels and risk of ischemic stroke. Methods Systematic literature searches were performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were studies investigating ischemic stroke risk in an adult population with measured Hcy levels. We computed odds ratios (ORs) for a 5 µmol/L increase in Hcy levels using a random effects meta-analysis. Results In total, 108 studies met the inclusion criteria of which 22 were rated as high-quality studies, and 20 studies included a dose-response analysis. Hcy levels were analyzed either as a continuous or categorical variable. The majority of the studies found an increased risk of ischemic stroke when comparing the highest-to-lowest Hcy strata. A graded association was observed over the Hcy strata, indicating a dose-response association, with the most apparent effect when Hcy levels exceeded approximately 15 µmol/L. No studies explored a potential nonlinear association between Hcy levels and ischemic stroke. Six studies were included in a meta-analysis, showing an OR of 1.43 (95% confidence interval [CI]: 1.28-1.61) per 5 µmol/L increase in Hcy levels. Conclusion This review and meta-analysis indicate a dose-response association between Hcy levels and ischemic stroke. An evident increase in effect measures was observed when Hcy levels exceeded 15 µmol/L, indicating a nonlinear association between ischemic stroke and Hcy levels. This nonlinear association warrants further study. This study is registered with clinical trial ( https://www.crd.york.ac.uk/prospero/ ; unique identifier: CRD42019130371).
Collapse
Affiliation(s)
- Marte Holmen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan F. H. Arendt
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
Wang L, Zhang Y. Role of hyperhomocysteine, thyroid dysfunction and their interaction in ischemic stroke patients with non-valvular atrial fibrillation. Sci Rep 2020; 10:12419. [PMID: 32709953 PMCID: PMC7382443 DOI: 10.1038/s41598-020-69449-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022] Open
Abstract
The role of hyperhomocysteinemia (HHcy) and thyroid dysfunction in ischemic stroke with non-valvular atrial fibrillation (AF) remains controversial. Till now, the relationship between HHcy and thyroid dysfunction in ischemic stroke with non-valvular AF has not been reported. The aim of this study was to investigate the role and relationship of HHcy and thyroid dysfunction in ischemic stroke patients with non-valvular AF. Seven hundred and seventeen patients with acute ischemic stroke within the first 7 days of symptom onset were consecutively included in this study. Eligible patients were divided into AF group and without AF group. Variables including age, sex, smoke, drink, history of stroke were collected. Levels of homocysteine (Hcy), thyroid-stimulating hormone were evaluated at presentation. Multivariable logistic regression and spearman bivariate correlate analysis were used to evaluate the relationship of HHcy and thyroid dysfunction in ischemic stroke patients with AF. There were 122 patients with AF and 595 patients without AF. Two hundred and eighty-eight (40.2%) patients had HHcy and Three hundred and sixteen (44.1%) patients had thyroid dysfunction. There was significant difference of serum Hcy (P = 0.014) and thyroxine levels (P = 0.002) between patients with and without AF. Furthermore, the difference of serum Hcy (P = 0.007) and thyroxine levels (P = 0.004) between patients with and without AF was also significant in female subgroups. We did not find association between HHcy and thyroid dysfunction in AF group (P = 0.463). In conclusion, both HHcy and thyroid dysfunction were associated with AF in patients with acute ischemic stroke and in female subgroup patients. However, thyroid dysfunction had no relationship with HHcy in ischemic stroke patients with AF.
Collapse
|
4
|
Rong H, Huang L, Jin N, Hong J, Hu J, Wang S, Xie Y, Pu J. Elevated Homocysteine Levels Associated with Atrial Fibrillation and Recurrent Atrial Fibrillation. Int Heart J 2020; 61:705-712. [PMID: 32727999 DOI: 10.1536/ihj.20-099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is increasing evidence linking plasma homocysteine levels and atrial fibrillation (AF). The association between an elevated level of plasma homocysteine and AF was examined by meta-analysis in this study.The PubMed and ScienceDirect databases until August 2019 were utilized to collect previous literature on homocysteine and the potential relation to AF. The pooled effects were evaluated depending on standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs), and the calculation was performed using Stata 12 software.A total of 11 validated articles were included in the meta-analysis. For pooled effect, the results confirmed that AF patients had higher homocysteine levels than control subjects (SMD: 0.58, 95%CI: 0.09-1.06). Compared with control subjects, homocysteine levels were higher in paroxysmal AF (SMD: 0.45, 95%CI: 0.18-0.72) and persistent AF patients (SMD: 1.21, 95%CI: 0.50-1.92). The pooled analysis suggested that patients with elevated homocysteine levels had markedly higher risk of AF compared with lower homocysteine levels in the categorical variable (OR: 2.21, 95%CI: 1.16-4.21) and continuous variable analyses (OR: 1.13, 95%CI: 1.00-1.27), respectively. In addition, the pooled analysis indicated that recurrent AF patients had significantly higher homocysteine levels than those without recurrence (SMD: 0.65, 95%CI: 0.42-0.88). The pooled analysis of the categorical variables indicated that elevated homocysteine levels were associated with increased risk of AF recurrence (OR: 3.81, 95%CI: 3.11-4.68). However, the association was weak in the pooled analysis of continuous variables (OR: 1.88, 95%CI: 0.74-4.81).Our meta-analysis identified that plasma homocysteine levels were significantly elevated in AF and recurrent AF patients. Elevated homocysteine is associated with increased risk of AF and AF recurrence.
Collapse
Affiliation(s)
- Hao Rong
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Lei Huang
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Nake Jin
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Jun Hong
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Jianan Hu
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Shanshan Wang
- Department of Cardiology, Ningbo Hangzhou Bay Hospital
| | - Yuquan Xie
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| |
Collapse
|
5
|
Mattia A, Azarpazhooh MR, Munoz C, Bogiatzi C, Quantz MA, Spence JD. Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves: a transcranial Doppler study. Stroke Vasc Neurol 2018; 2:198-203. [PMID: 29507780 PMCID: PMC5829912 DOI: 10.1136/svn-2017-000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/03/2022] Open
Abstract
Objectives Microembolic signals (MES) on transcranial Doppler (TCD) predict stroke and cognitive decline. Plasma levels of total homocysteine (tHcy), a prothrombotic factor, are higher in patients with microemboli in carotid stenosis and in patients with paradoxical embolism. In this study we assessed the association between the level of tHcy and the number of MES in patients with mechanical heart valves (MHVs). Methods TCD monitoring was performed to detect MES before and after breathing 100% oxygen and repeated every 2-4 weeks up to six times. Results Twenty-five patients with MHVs (mean age: 63.60±10.15 years) participated in this study; 15 were men (66.47±7.25 years) and 10 were women (59.30±12.60 years). In total, there were 126 study visits. In multiple regression, higher tHcy was associated with more MES in both preoxygenation (OR 1.34 (95% CI 1.07 to 1.68, P=0.009)) and postoxygenation (OR 1.40 (95% CI 1.07 to 1.83, P=0.01)) phases. Current smoking and the length of time between the operation and monitoring also correlated with a higher number of MES before and after breathing oxygen, particularly in women. Conclusions Higher tHcy and smoking were associated with a higher MES count in both preoxygenation and postoxygenation phases. Because smoking can be stopped and hyperhomocysteinaemia is treatable, these are clinically important findings.
Collapse
Affiliation(s)
- Alicia Mattia
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - M Reza Azarpazhooh
- Division of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Neurology, Western University, London, Ontario, Canada
| | - Claudio Munoz
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Chrysi Bogiatzi
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Mackenzie A Quantz
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Neurology, Western University, London, Ontario, Canada.,Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| |
Collapse
|
6
|
Yao Y, Shang MS, Dong JZ, Ma CS. Homocysteine in non-valvular atrial fibrillation: Role and clinical implications. Clin Chim Acta 2017; 475:85-90. [PMID: 29050786 DOI: 10.1016/j.cca.2017.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with a series of adverse complications that cause so-called AF socioeconomic burden. Apart from the classical risk factors, it seems to be novel factors that increase the risk of AF and AF-related stroke. Recently, more and more evidence has well documented the close relationships between homocysteine (Hcy) and AF. As a well-known marker for pro-oxidation and pro-inflammation, Hcy plays an important role in a number of vascular diseases having strong association with AF. This review will discuss the expression of Hcy and its association with ischemic stroke in AF patients especially for elderly patients, and the role and clinical implications of Hcy in the thromboembolic events and rhythm outcome in AF patients. The possible mechanisms linking elevated Hcy and cardiovascular events in AF patients will also be addressed, including oxidative stress, inflammatory response, atrial remodeling, etc.
Collapse
Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China.
| | - Mei-Sheng Shang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
7
|
Yao Y, Shang MS, Gao LJ, Zhao JH, Yang XH, Liu T, Tang RB, Jiang CX, Long DY, Ning M, Zhu H, Lv Q, Hu R, Du X, Dong JZ. Elevated homocysteine increases the risk of left atrial/left atrial appendage thrombus in non-valvular atrial fibrillation with low CHA2DS2-VASc score. Europace 2017. [PMID: 28637244 DOI: 10.1093/europace/eux189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Mei-sheng Shang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Li-Jian Gao
- Center for coronary heart disease, Department of Cardiology, Cardiovascular Institute & Fuwai Hospital, CAMS & PUMC, National Center for Heart Disease, No 167 Beilishi Road, Xicheng District, Beijing, P. R. China
| | - Jing-hua Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Xiao-hui Yang
- Beijing Municipal Office for Cardiovascular Disease Prevention & Control, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, P. R. China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Ri-bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Chen-xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - De-yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Hui Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| | - Jian-zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
| |
Collapse
|
8
|
Tokatli A, Yiginer O, Ozmen N, Uzun M, Kilicaslan F. Paroxysmal atrial fibrillation and related thromboembolism may be a hidden factor in the development of dementia. Psychogeriatrics 2016; 16:382-383. [PMID: 26781960 DOI: 10.1111/psyg.12186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Alptug Tokatli
- Department of Cardiology, Golcuk Military Hospital, Kocaeli, Turkey
| | - Omer Yiginer
- Department of Cardiology, GATA Haydarpasa Hospital, Istanbul, Turkey
| | - Namik Ozmen
- Department of Cardiology, GATA Haydarpasa Hospital, Istanbul, Turkey
| | - Mehmet Uzun
- Department of Cardiology, GATA Haydarpasa Hospital, Istanbul, Turkey
| | | |
Collapse
|
9
|
Tascilar N, Ekem S, Aciman E, Ankarali H, Mungan G, Ozen B, Unal A. Hyperhomocysteinemia as an Independent Risk Factor for Cardioembolic Stroke in the Turkish Population. TOHOKU J EXP MED 2009; 218:293-300. [DOI: 10.1620/tjem.218.293] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nida Tascilar
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Sureyya Ekem
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Esra Aciman
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Handan Ankarali
- Department of Biostatistics, Zonguldak Karaelmas University Medical Faculty
| | - Gorkem Mungan
- Department of Biochemistry, Zonguldak Karaelmas University Medical Faculty
| | - Banu Ozen
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Aysun Unal
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| |
Collapse
|
10
|
Oneglia C, Gardini A, Benedini G, Cappato R, Rusconi C. Regression of warfarin-resistant left atrial appendage thrombus after ablation of atrial fibrillation and permanent pacing. J Cardiovasc Med (Hagerstown) 2006; 7:628-30. [PMID: 16858243 DOI: 10.2459/01.jcm.0000237912.18753.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance and can also occur in absence of true cardiac disease. However, also in these cases, it can generate left atrial appendage thrombi with systemic embolic potential. A regular and well conducted anticoagulant therapy with dicoumarol derivatives, as indicated in these patients, is not always successful. We report the case of a patient with lone atrial fibrillation and a left atrial appendage thrombus resistant to anticoagulant therapy with warfarin, which disappeared after catheter ablation of atrial fibrillation by electrical disconnection of the pulmonary veins, restoration of sinus rhythm and dual-chamber pacemaker implantation.
Collapse
Affiliation(s)
- Carlo Oneglia
- Cardiology Unit, S. Orsola Hospital, Brescia, Italy.
| | | | | | | | | |
Collapse
|
11
|
Poli D, Antonucci E, Cecchi E, Marcucci R, Liotta AA, Cellai AP, Lenti M, Gensini GF, Abbate R, Prisco D. Culprit Factors for the Failure of Well-Conducted Warfarin Therapy to Prevent Ischemic Events in Patients With Atrial Fibrillation. Stroke 2005; 36:2159-63. [PMID: 16179567 DOI: 10.1161/01.str.0000183620.06179.7b] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE In patients with atrial fibrillation (AF), oral anticoagulant therapy (OAT) is effective in reducing stroke and embolism. However, despite OAT, ischemic events do occur in some patients. Studies specifically addressing the identification of risk factors for ischemic events during well-conducted OAT are not available. In this study, we prospectively investigated the role of classic risk factors and homocysteine levels in the occurrence of ischemic complications in 364 AF patients on OAT. METHODS The quality of anticoagulation levels and the occurrence of bleeding and thrombotic events were recorded. RESULTS During follow-up (859 patient years) 21 patients had ischemic complications (rate 2.4 x 100 patient-years). Homocysteine plasma levels were higher in these patients than in patients without ischemic complications during OAT (P<0.01), whereas no difference was observed in relation to the quality of OAT. The presence of a history of previous ischemic events, hypertension, and homocysteine plasma levels over the 90th percentile were all associated with an increased risk of ischemic events during OAT (odds ratio [OR]=7, 4.5, and 4.7, respectively). The coexistence of these risk factors markedly increased the risk (OR=13.1; 95% CI, 3.7 to 45.7; P=0.001). CONCLUSIONS In conclusion, our results indicate that AF patients with multiple risk factors may not be sufficiently protected by OAT, even when this is well conducted.
Collapse
Affiliation(s)
- Daniela Poli
- Department of Critical Care Medicine, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Marcucci R, Betti I, Cecchi E, Poli D, Giusti B, Fedi S, Lapini I, Abbate R, Gensini GF, Prisco D. Hyperhomocysteinemia and vitamin B6 deficiency: new risk markers for nonvalvular atrial fibrillation? Am Heart J 2004; 148:456-61. [PMID: 15389232 DOI: 10.1016/j.ahj.2004.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A recent "ex-vivo" study showed that nonvalvular atrial fibrillation (NVAF) is associated with enhanced activity of metalloproteinases at the atrial level, and in animal models homocysteine (Hcy) is able to activate metalloproteinases. The aim of this case-control study was to investigate the association of total Hcy plasma levels, vitamin status (folate, vitamin B6, and vitamin B12), and methylenetetrahydrofolate reductase C677T and CBS 844ins68 polymorphisms with NVAF. Furthermore, the role of these variables in the occurrence of ischemic events was investigated. METHODS We studied 310 NVAF patients on oral anticoagulant treatment (168 patients with previous ischemic events and 142 without) and 310 controls. RESULTS Hyperhomocysteinemia (highest quartile) and vitamin B6 deficiency (lowest quartile) were independently associated with NVAF after multivariate analysis (Hcy: odds ratio [OR] 6.40, 95% CI 3.29-12.46; vitamin B6: OR 3.02, 95% CI 1.02-8.95). A significant correlation was found between Hcy levels and left atrial diameter (r = 0.46; P <.001). As shown by multivariate analysis, elevated Hcy levels were an independent risk factor for ischemic complications during NVAF (OR 2.66, 95% CI 1.15-6.20). CONCLUSIONS This study demonstrates a significant association of both elevated Hcy levels and low vitamin B6 levels with the presence of NVAF; in addition, it confirms the role of Hcy as a risk factor for ischemic events during NVAF.
Collapse
Affiliation(s)
- Rossella Marcucci
- Department of Medical and Surgical Critical Care, University of Florence, Florence Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Nadar S, Blann A, Lip GYH. Homocysteine is unlikely to be associated with the risk of thromboembolic complications in atrial fibrillation. Blood Coagul Fibrinolysis 2003; 14:513-4. [PMID: 12851541 DOI: 10.1097/00001721-200307000-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|