Plasma Homocysteine is a Predictive Factor for Arterial Stiffness: A Community-Based 4.8-Year Prospective Study

H-Type Hypertension among Black South Africans and the Relationship between Homocysteine, Its Genetic Determinants and Estimates of Vascular Function

Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among Black South Africans. We included 1995 adults (63% female). Plasma Hcy and cardiovascular measures (systolic and diastolic BP (SBP, DBP), pulse pressure, heart rate (HR), carotid-radialis pulse wave velocity (cr-PWV), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1) were quantified. Five Hcy-related polymorphisms (cystathionine β-synthase (CBS 844ins68, T833C, G9276A); methylenetetrahydrofolate reductase (MTHFR C677T) and methionine synthase (MTR A2756G)) were genotyped. Hcy was >10 µmol/L in 41% (n = 762), and of the 47% (n = 951) hypertensives, 45% (n = 425) presented with H-type. Hcy was higher in hypertensives vs. normotensives (9.86 vs. 8.78 µmol/L, p < 0.0001, effect size 0.56) and correlated positively with SBP, DBP, cr-PWV and ICAM-1 (r > 0.19, p < 0.0001). Over Hcy quartiles, SBP, DBP, HR, cr-PWV and ICAM-1 increased progressively (all p-trends ≤ 0.001). In multiple regression models, Hcy contributed to the variance of SBP, DBP, HR, cr-PWV and ICAM-1. H-type hypertensives also had the lowest MTHFR 677 CC frequency (p = 0.03). Hcy is positively and independently associated with markers of vascular function and raised BP.

Is heart-type fatty acid binding protein (H-FABP) a valid marker of arterial stiffness in patients with systemic sclerosis?

Background/Aim: Both micro- and macro-vascular involvement has been researched in systemic sclerosis (SSc) for many years. In this study, the relationship of arterial stiffness with heart-type fatty acid binding protein (h-FABP), which is well-accepted as a cardiac marker, was investigated for the first time. Methods: In this case-control study, 40 patients diagnosed with SSc between the ages of 18 and 65 were included. Thirty healthy individuals of similar age and gender were included as the control group. Patients were excluded from the study if they had cardiovascular risk factors, active infections, and/or malignancies. Along with detecting biochemical markers in the blood, results from methods, such as 24-h blood pressure Holter recordings, pulse-wave velocities (PWV), and echocardiograms (ECHO) were obtained from patients. Results: The homocysteine mean level was higher in the patient group than in the control group (P < 0.001). H-FABP and asymmetric dimethylarginine (ADMA) means were similar between the two groups (P = 0.286 and P = 0.340, respectively). Vascular parameters, including mean arterial pressure (MAP), augmentation index normalized to the 75 /min heart rate (AIx @ 75), and PWV were also similar between the two groups (P = 0.498, P = 0.382 and P = 0.180, respectively). Conclusion: It can be concluded that no ongoing myocardial damage occurs based on normotensive Holter findings, normal h-FABP levels, and ECHO findings in our patients. It is suggested that vasodilatory treatments, such as pentoxifylline and calcium channel blockers, which the patients receive for SSc treatment due to Raynaud Syndrome, may protect them from hypertension and therefore offer protection from myocardial damage.

Effects of tofacitinib therapy on arginine and methionine metabolites in association with vascular pathophysiology in rheumatoid arthritis: A metabolomic approach

Introduction

Rheumatoid arthritis (RA) has been associated with changes in lipid, arginine and NO metabolism with increased cardiovascular (CV) risk. The aim of this study is to evaluate the effect of tofacitinib, a Janus kinase (JAK) inhibitor, on arginine and methionine metabolism in correlation with inflammation, functional and pathological vascular changes during one-year treatment of patients with RA.

Materials and methods

Thirty RA patients with active disease were treated with either 5 mg bid or 10 mg bid tofacitinib for 12 months. We determined DAS28, CRP, IgM rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) levels. We assessed brachial artery flow-mediated vasodilation (FMD), carotid intima-media thickness (IMT) and pulse-wave velocity (PWV) by ultrasound at baseline and after 6 and 12 months. We also determined plasma L-arginine, L-citrulline, L-ornithine, inducible nitric oxide synthase (iNOS), asymmetric (ADMA) and symmetric dimethylarginine (SDMA), L-N-monomethyl-arginine (L-NMMA), cysteine, homocysteine, and methionine levels at these time points.

Results

Twenty-six patients (13 on each arm) completed the study. CRP, ESR and DAS28 decreased significantly during one-year treatment with tofacitinib. Arginine and ADMA showed a negative univariate correlation with CRP but not with FMD, PWV or IMT. Tofacitinib at 10 mg bid significantly increased L-arginine, L-ornithine, iNOS and methionine levels after 12 months. ADMA and SDMA levels did not change in our study. Methionine showed negative correlation with FMD at baseline and positive correlation with PWV after 12 months. No change was observed in FMD and PWV but a significant increase was measured in IMT at 6 and 12 months. Multivariate analysis indicated variable correlations of L-arginine, L-citrulline, ADMA, L-NMMA, homocysteine and methionine with DAS28, CRP, ESR and RF but not with anti-CCP after one-year treatment. With respect to vascular pathophysiology, only PWV and methionine correlated with each other.

Conclusion

One-year tofacitinib treatment suppressed systemic inflammation and improved functional status in RA. FMD, PWV have not been affected by one-year tofacitinib treatment., while IMT increased further despite treatment. Increased arginine and methionine might contribute to the anti-inflammatory effects of tofacitinib. Increased arginine availability with no changing ADMA may protect FMD and PWV from deterioration. The increase of IMT in the anti-inflammatory environment cannot be explained by arginine or methionine metabolism in this study.

Mutual effect of homocysteine and uric acid on arterial stiffness and cardiovascular risk in the context of predictive, preventive, and personalized medicine

Background

Arterial stiffness is a major risk factor and effective predictor of cardiovascular diseases and a common pathway of pathological vascular impairments. Homocysteine (Hcy) and uric acid (UA) own the shared metabolic pathways to affect vascular function. Serum uric acid (UA) has a great impact on arterial stiffness and cardiovascular risk, while the mutual effect with Hcy remains unknown yet. This study aimed to evaluate the mutual effect of serum Hcy and UA on arterial stiffness and 10-year cardiovascular risk in the general population. From the perspective of predictive, preventive, and personalized medicine (PPPM/3PM), we assumed that combined assessment of Hcy and UA provides a better tool for targeted prevention and personalized intervention of cardiovascular diseases via suppressing arterial stiffness.

Methods

This study consisted of 17,697 participants from Beijing Health Management Cohort, who underwent health examination between January 2012 and December 2019. Brachial-ankle pulse wave velocity (baPWV) was used as an index of arterial stiffness.

Results

Individuals with both high Hcy and UA had the highest baPWV, compared with those with low Hcy and low UA (β: 30.76, 95% CI: 18.36-43.16 in males; β: 53.53, 95% CI: 38.46-68.60 in females). In addition, these individuals owned the highest 10-year cardiovascular risk (OR: 1.49, 95% CI: 1.26-1.76 in males; OR: 7.61, 95% CI: 4.63-12.68 in females). Of note, males with high homocysteine and low uric acid were significantly associated with increased cardiovascular risk (OR: 1.30, 95% CI: 1.15-1.47), but not the high uric acid and low homocysteine group (OR: 1.02, 95% CI: 0.90-1.16).

Conclusions

This study found the significantly mutual effect of Hcy and UA on arterial stiffness and cardiovascular risk using a large population and suggested the clinical importance of combined evaluation and control of Hcy and UA for promoting cardiovascular health. The adverse effect of homocysteine on arteriosclerosis should be addressed beyond uric acid, especially for males. Monitoring of the level of both Hcy and UA provides a window opportunity for PPPM/3PM in the progression of arterial stiffness and prevention of CVD. Hcy provides a novel predictor beyond UA of cardiovascular health to identify individuals at high risk of arterial stiffness for the primary prevention and early treatment of CVD. In the progressive stage of arterial stiffness, active control of Hcy and UA levels from the aspects of dietary behavior and medication treatment is conducive to alleviating the level of arterial stiffness and reducing the risk of CVD. Further studies are needed to evaluate the clinical effect of Hcy and UA targeted intervention on arterial stiffness and cardiovascular health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-022-00298-x.

The significance of homocysteine in patients with hypertension

Cardiovascular disease is the most common cause of death in developed countries. Important factors leading to ischemic heart disease and strokes are hypertension and high levels of homocysteine in blood serum. The coexistence of these two factors significantly increases the risk of these diseases and premature deaths. Many studies indicate that patients with hypertension are significantly more likely to demonstrate increased blood serum homocysteine levels than those with normal blood pressure. This may be caused by a higher incidence of overweight, high intake of salt and increased uric acid levels. It has been shown that both these factors increase the prevalence of hypertension and lead to higher homocysteine levels. However, the results of some studies indicate that arterial hypertension and homocysteinemia are causally related. It was shown, among other things, that high homocysteine levels damage the endothelium and reduce nitric oxide synthesis, which may directly lead to hypertension. Serum homocysteine levels are slightly higher in patients with white coat hypertension than they are in healthy individuals and may therefore also increase the risk of cardiovascular diseases. Several authors have also shown that the levels of homocysteine in blood serum are higher in so-called non-dippers, i.e., patients with no night-time pressure drop. The lack of a 10%–20% decrease in blood pressure at night is associated with increased cardiovascular complications. Strokes occur especially frequently in older people with arterial hypertension and hyperhomocysteinemia. The administration of B vitamins and folic acid significantly reduces serum homocysteine levels. The administration of this acid also slightly, but statistically significantly, increases the effectiveness of hypotensive drugs. Large meta-analyses meta-analysis indicate that the increased supply of folic acid in patients with hypertension significantly reduces the risk of stroke. Such management is particularly effective in patients with hypertension and hyperhomocysteinemia.

Joint Association of Serum Homocysteine and High-Sensitivity C-Reactive Protein with Arterial Stiffness in Chinese Population: A 12-Year Longitudinal Study

BACKGROUND

Elevated plasma homocysteine (Hcy) and high-sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular diseases. However, it is unclear whether the coexistence of these conditions accelerates the risk of arterial stiffness. Our study aimed to evaluate the association of combined Hcy and hsCRP with arterial stiffness in Chinese middle-aged adults.

MATERIAL/METHODS

We conducted a 12-year longitudinal study in 220 individuals in Hanzhong, China, from 2005 to 2017. The average age at follow-up was 41.83 ± 3.10 years. Demographic information, medical history, anthropometric measurements, and blood pressure as well as urine and fasting blood samples, including Hcy, hsCRP, and brachial-ankle pulse wave velocity (baPWV) were measured and analyzed.

RESULTS

BaPWV levels showed a linear growth trend with the increasing of hsCRP (p for trend <0.01). The ORs in the highest quartile compared to the lowest quartile were 1.985 (95% CI 0.776-5.077; p = 0.152) and 3.960 (95% CI 1.468-10.684; p= 0.007) for Hcy and hsCRP, respectively. When Hcy and hsCRP were combined, subjects in both the highest quartile of Hcy and hsCRP (Hcy ≥15.50 μmol/L and hsCRP ≥0.82 μmol/L) had a 12.68-fold increased risk of developing arterial stiffness at the 12-year follow-up compared to those in the lowest quartile of Hcy and hsCRP (Hcy ≤9.91 μmol/L and hsCRP ≤0.19 μmol/L) after adjusting for potential confounders.

CONCLUSIONS

The present study demonstrated that the combination of elevated serum Hcy and hsCRP may contribute to an increased risk of arterial stiffness.

Association between Homocysteine and Arterial Stiffness in Women with a History of Preeclampsia

Growing evidence has reported that a history of preeclampsia (PE) increases the risk of developing cardiovascular disease (CVD). Arterial stiffness plays a predictive role in CVD. Previous studies have demonstrated the close association between homocysteine (Hcy) level and arterial stiffness in community-based populations. This study was to assess whether Hcy level was independently associated with arterial stiffness in 168 women with a PE history who were analyzed at a 5-year follow-up. Brachial-ankle pulse wave velocity (baPWV) was measured by an automatic pulse-wave analyzer and a value >1,400 cm/s was defined as high arterial stiffness. Biochemical parameters were recorded and an Hcy value >10 μmol/L was defined as having hyperhomocysteine (H-Hcy). Variables that were significantly associated with baPWV were tested for independence by multivariate logistic regression analysis. We found that body mass index (OR 1.017, 95% CI 1.008-1.029), systolic blood pressure (OR 1.048, 95% CI 1.019-1.072), total cholesterol (OR 1.059, 95% CI 1.007-1.086), and Hcy level (OR 1.021, 95% CI 1.010-1.037) were independent determinants of baPWV in women with previous PE. Our findings indicate that Hcy pathway might be involved in arterial stiffness in women with a PE history. Whether Hcy would be a promising biomarker for serial stratified CVD risk management in these women deserves further evaluation on a large scale.

Pulse wave velocity and its gender-related associations with cardiovascular risk factors in a high cardiovascular risk population

Introduction

Associations found between pulse wave velocity (PWV) and cardiovascular risk factors (CVrF) are diverse. We aimed to evaluate whether differences in PWV and its associations with CVrF in a high cardiovascular risk population exist between genders and between the whole population (WHgr) and groups of apparently healthy (AHgr) and those of hypertensive, obese or diabetics (Rgr).

Material and methods

Pulse wave velocity measured by Arteriograph was investigated in 805 adults aged 20-65, randomly selected from the Tallinn Population Register.

Results

Pulse wave velocity was the highest in Rgr and no differences were found between genders of the same group. In women of WHgr and AHgr age and SBP with addition of BMI and apolipoprotein B (ApoB) were associated with 54% and 48%, and without ApoB in Rgr with only 30% of PWV values. In men aged ≥ 50 of WHgr with elevated SBP odds ratios for increased PWV were 25.3 and 3.5, in Rgr 21.2 and 2.2, in those aged ≥ 50 AHgr 28.4. In women aged ≥ 50 of WHgr with elevated SBP and diabetes odds ratios were 5.5, 4.9 and 4.0, in Rgr with elevated SBP and diabetes 3.6 and 3.7, in those aged ≥ 50 AHgr 29.3.

Conclusions

The associations of ApoB and BMI with PWV and diabetes with elevated PWV indicative of increased aortic stiffness were unique for women. Aging and SBP were related to PWV even in AHgr, although age ≥ 50 years in Rgr women and normal SBP in AHgr were not associated with elevated PWV.

High-density lipoprotein 3 cholesterol is a predictive factor for arterial stiffness: a community-based 4.8-year prospective study

Background

Although drug trials with niacin and cholesteryl ester transfer protein inhibitors that substantially increase high-density lipoprotein-cholesterol (HDL-C) failed to reduce the risk of coronary heart disease, HDL protection of the cardiovascular system cannot be easily denied. Hence, it may be HDL subfractions that are responsible for the long-held and consistent cardioprotective association of HDL. Arterial stiffness has been increasingly recognized as a strong predictor of subclinical vascular disease, atherosclerotic disease, and cardiovascular mortality. As the association of HDL subfractions and arterial stiffness is not well characterized, we aimed to determine the relations between these two entities in a community-based longitudinal Chinese population sample.

Methods

We evaluated the associations of plasma HDL2-C and HDL3-C subfractions with arterial stiffness measured using carotid-femoral pulse wave velocity (cf-PWV) and then multivariate logistic regression in 1447 subjects (mean age 61.3 years) from a community-based population in Beijing, China.

Results

After a median follow-up of 4.8 years, Pearson’s correlation analysis revealed that HDL3-C was negatively associated with follow-up cf-PWV (r = −0.114; P = 0.001), and there was no correlation between HDL2-C and follow-up cf-PWV (r = −0.045; P = 0.181). In the multivariate logistic regression analysis, each standard deviation (SD) increase in HDL3-C was associated with a 1.490-increased likelihood of the presence of follow-up cf-PWV [odds ratio (per SD increase in HDL3-C) 1.490; 95% confidence interval 1.021–1.470; P = 0.039), whereas there was no relation between HDL2-C and follow-up cf-PWV.

Conclusions

HDL3-C subfractions were significantly and inversely associated with arterial stiffness, suggesting that HDL subfractions are likely more important than HDL-C in preventing cardiovascular disease.

Arterial Stiffness and Hypertension - Which Comes First?

Arterial hypertension is one of the traditional risk factors involved in the development of cardiovascular events, while arterial stiffness is an independent predictor of cardiovascular disease in patients with hypertension. It seems that the risk factors involved in the pathology of uncontrolled hypertension are similar to those that contribute to the development of arterial stiffness. After evidence showed that arterial stiffness is an independent prognostic factor for the occurrence of cardiovascular events in patients with arterial hypertension, the importance of assessing arterial stiffness was recognized in a document drafted by the European Society of Hypertension in 2007. Many factors, some still insufficiently studied, are involved in the development and worsening of arterial stiffness, especially in patients with certain comorbidities (diabetes, hypertension, chronic kidney disease). The evaluation of pulse wave velocity (PWV) remains the gold standard for non-invasive assessment of arterial stiffness. It seems that changes in terms of lifestyle and drug therapy have some positive effects on improving arterial stiffness, but further studies are needed to prove this concept. Our review aims to highlight the novelty of the mechanisms, the assessment methods, some of the clinical aspects, as well as the therapeutic implications of arterial stiffness, especially in patients with hypertension.

Positive Association of Plasma Homocysteine Levels with Cardio-Ankle Vascular Index in a Prospective Study of Japanese Men from the General Population

AIM

Observational studies have reported that elevated homocysteine (Hcy) levels are associated with the risk of cardiovascular disease (CVD). However, interventions that lower Hcy do not provide a corresponding risk reduction. Therefore, the causal role of Hcy in CVD remains unclear. This 5-year prospective study investigated the associations of Hcy levels, folate intake, and host factors with arterial stiffness among the general Japanese population.

METHODS

We prospectively recruited 658 participants (40-69 years old) from the general population during regular health checkup examinations. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) at baseline and the 5-year follow-up. Folate intake was estimated using a structured questionnaire. Genotyping was used to evaluate the MTHFR C677T and MS A2756G gene polymorphisms. Ultrafast liquid chromatography was used to measure total plasma Hcy levels. Association between these variables and CAVI values was evaluated using general linear regression and logistic regression models that were adjusted for atherosclerosis-related factors.

RESULTS

Men had higher Hcy levels and CAVI values and lower folate intake than women (all, p＜0.001). At baseline, Hcy, folate intake, and the two genotypes were not associated with CAVI values for both sexes. Among men, Hcy levels were positively associated with CAVI values at the 5-year follow-up (p=0.033). Folate intake and the two genotypes were not associated with the 5-year CAVI values.

CONCLUSION

Plasma Hcy may be involved in arterial stiffness progression, as monitored using CAVI, among men.