Is There any Difference in Plasma Homocysteine Levels Among Various Clinical Types of Angiographically Determined Coronary Artery Disease

Recent studies have shown that moderately elevated plasma homocysteine concentrations are an independent risk factor for coronary artery disease (CAD). In addition, it has been demonstrated that elevated plasma homocysteine level increases mortality in patients with acute coronary syndrome. But, there is no study that has demonstrated whether there is any difference between clinical varieties of CAD with respect to plasma homocysteine levels. The aim of the present study was to examine the plasma homocysteine levels in various clinical presentations of CAD. In this study, consecutive 123 patients (94 male, mean age: 54.4 ± 9,6 years) with significant (?%50) coronary artery disease were recruited together with age-matched 30 healthy subjects as control group (24 male, mean age: 53.6 ± 9.9 years) whose coronary angiograms were normal. Patients with CAD were divided into four different groups according to their clinical types of CAD. Group 1: patients with exercise angina (n: 27); group 2: patients with class III unstable angina pectoris or non-ST elevation acute myocardial infarction (n: 43). Group 3: patients with ST elevation acute myocardial infarction (n: 33). Group 4: patients with old (>2 month) myocardial infarction or those subjected to percutan enous transluminal coronary angioplasty or coronary artery by-pass graft operation, with no angina pectoris (n: 20). Venous blood samples were collected from all groups on admission to the hospital. Plasma homocysteine concentrations were measured by high-performance liquid chromatography with fluorescence detection. Plasma homocysteine levels were significantly higher than the control group in patients with CAD (8.64 ± 1.52 µmol/L, 14.92 ± 4.25 µmol/L; p<0.001, respectively). But, there were no significant differences of homocysteine concentrations among patients with CAD sub-groups (14.52 ± 3.99 µmol/L; 15.18 ± 4.51 µmol/L; 15.37 ± 4.68 µmol/L; 14.33 ± 3.35 µmol/L). This result shows that a significant difference for plasma homocysteine levels does not exist among clinical types of CAD in patients with angiographically determined CAD.