Homocysteine levels, H-Hypertension, and the MTHFR C677T genotypes: A complex interaction

Background and objectives

High homocysteine levels are associated with increased risk of hypertension and stroke. Homocysteine is metabolized by the methylenetetrahydrofolate reductase (MTHFR). We aimed to investigate the levels of homocysteine and their association with hypertension, stroke, and antihypertensive medication usage in patients with different MTHFR C677T genotypes.

Methods and results

Genotype frequency of MTHFR polymorphism was performed, and plasma homocysteine levels were measured in 2,640 adult Lebanese patients. Hypertension, history of stroke, and list of medications were documented, among other clinical and demographic parameters. The TT mutant genotype and the T mutant allele of MTHFR were more prevalent in hyperhomocysteinemia (HHcy) and H-hypertensive (H-HTN, defined as hypertension with hyperhomocysteinemia) patients when compared to non-HHcy subjects and non H-HTN patients respectively. Homocysteine levels were significantly higher in hypertensive patients specifically among those on diuretics. A higher level of homocysteine was found in hypertensive patients with the MTHFR T allele compared to patients carrying the C allele. Among the T allele carriers, the average plasma homocysteine level was 13.3 ± 0.193 μmol/L for hypertensive subjects compared to 11.9 ± 0.173 μmol/L (non-hypertensives). Furthermore, homocysteine levels significantly correlated with stroke risk in patients with the T alleles.

Conclusions

We found an association of homocysteine with hypertension, hypertensive medication, and stroke risk among patients with the MTHFR T allele and the TT genotype. The association of diuretics therapy with higher homocysteine levels calls for routine measurements and therapeutic control of homocysteine in patients on diuretic, to improve health-related outcomes.

Pharmacotherapy of obesity: an update on the available medications and drugs under investigation

Obesity is an epidemic and a public health threat. Medical weight management remains one of the options for the treatment of excess weight and recent advances have revolutionized how we treat, and more importantly how we will be treating obesity in the near future. Metreleptin and Setmelanotide are currently indicated for rare obesity syndromes, and 5 other medications (orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, semaglutide) are approved for non-syndromic obesity. Tirzepatide is about to be approved, and other drugs, with exciting novel mechanisms of action primarily based on incretins, are currently being investigated in different phases of clinical trials. The majority of these compounds act centrally, to reduce appetite and increase satiety, and secondarily, in the gastrointestinal tract to slow gastric emptying. All anti-obesity medications improve weight and metabolic parameters, with variable potency and effects depending on the specific drug. The currently available data do not support a reduction in hard cardiovascular outcomes, but it is almost certain that such data are forthcoming in the very near future. The choice of the anti-obesity medication needs to take into consideration the patient's clinical and biochemical profile, co-morbidities, and drug contra-indications, as well as expected degree of weight loss and improvements in cardio-renal and metabolic risk. It also remains to be seen whether precision medicine may offer personalized solutions to individuals with obesity, and whether it may represent the future of medical weight management along with the development of novel, very potent, anti-obesity medications currently in the pipeline.

Funding

None.

A Perspective From the Middle East on the Topic of Concussion

Background: Concussion is the most prevalent form of traumatic brain injury. Western countries debate it as a public health issue. Middle Eastern (ME) countries lag behind with a concussion incidence surveillance of 25% that of European countries. Objective: The purpose of our study was to review concussion resulting from traumatic brain or sports injuries in civilian nationals of the ME. Methods: We carried out PubMed literature search of all related articles in the past thirty years using search terms reflecting concussion and sports injuries in ME countries of Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen. Results: 72 articles met our search criteria with relatively little data found on concussion within the parameters of this review. However, the reports that were found were diverse. Israel, Turkey and Iran led in publications. Motor vehicle accidents were the leading cause of concussion from TBI (50-57%) followed by domestic injuries (30-40%) and sports injuries at 4-7%. Extremity injuries were most commonly reported unlike head injuries often invisible and underreported. Male gender, young children, pedestrian and car traffic accidents, lack of protective gear, cell phone use, impulsive behaviors as well as training overload, lack of sleep, contact sports and violence were all risk factors for concussion. Conclusions: In this review, we highlighted the nascent topic of concussion in the ME and the need for additional research dictating awareness programs and implementing new safety policies to lower morbidity and mortality across all ages.