The Treatment of Hyperhomocysteinemia
- 1 February 2009
- journal article
- review article
- Published by Annual Reviews in Annual Review of Medicine
- Vol. 60 (1), 39-54
- https://doi.org/10.1146/annurev.med.60.041807.123308
Abstract
The unique biochemical profile of homocysteine is characterized by chemical reactivity supporting a wide range of molecular effects and by a tendency to promote oxidant stress–induced cellular toxicity. Numerous epidemiological reports have established hyperhomocysteinemia as an independent risk factor for cardiovascular disease, cerebrovascular disease, dementia-type disorders, and osteoporosis-associated fractures. Although combined folic acid and B-vitamin therapy substantially reduces homocysteine levels, results from randomized placebo-controlled clinical trials testing the effect of vitamin therapy on outcome in these diseases have generally fallen short of expectations. These results have led some to abandon homocysteine monitoring in the management of patients with cardiovascular or cognitive disorders. These trials, however, have generally included patients with only mildly elevated homocysteine levels and have not addressed several clinical scenarios in which homocysteine reduction may be effective, including the primary prevention of atherothrombotic disease in individuals at low or intermediate risk, or those with severe hyperhomocysteinemia.Keywords
This publication has 91 references indexed in Scilit:
- Effect of Folic Acid and B Vitamins on Risk of Cardiovascular Events and Total Mortality Among Women at High Risk for Cardiovascular DiseaseJAMA, 2008
- Large-Scale Analysis of Association Between LRP5 and LRP6 Variants and OsteoporosisJAMA, 2008
- Randomized Clinical Trial of Homocysteine Level–Lowering Therapy and FracturesArchives of Internal Medicine, 2007
- The role of hyperhomocysteinemia as well as folate, vitamin B6 and B12 deficiencies in osteoporosis – a systematic reviewcclm, 2007
- Effect of Folate and Mecobalamin on Hip Fractures in Patients With StrokeJAMA, 2005
- Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and HospitalizationThe New England Journal of Medicine, 2004
- Methylenetetrahydrofolate reductase gene C677T and A1298C polymorphisms, plasma homocysteine, folate, and vitamin B12 levels and the extent of coronary artery diseaseThe American Journal of Cardiology, 2004
- Plasma Homocysteine as a Risk Factor for Dementia and Alzheimer's DiseaseThe New England Journal of Medicine, 2002
- Homocysteine and DementiasThe New England Journal of Medicine, 2002
- The Effect of Folic Acid Fortification on Plasma Folate and Total Homocysteine ConcentrationsThe New England Journal of Medicine, 1999