Intérêt de l’homocystéine dans l’évaluation du risque cardiovasculaire au CHRU de Nancy - Université de Lorraine Access content directly
Master Thesis Year : 2020

Cardiovascular Manifestations of Intermediate and Major Hyperhomocysteinemia Due to Vitamin B12 and Folate deficiency and/or Inherited Disorders of One-Carbon Metabolism : A 3.5-years Retrospective Cross-sectional Study of Consecutive Patients

Intérêt de l’homocystéine dans l’évaluation du risque cardiovasculaire au CHRU de Nancy

Julien Lévy
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Abstract

BACKGROUND: The association of moderate hyperhomocysteinemia (HHcy) (15–30 μmol/L) with cardiovascular diseases (CVD) in most observational studies has been challenged by the lack of benefit of vitamin supplementation to lowering homocysteine. Consequently, the results of interventional studies have confused the debate regarding the management of patients with intermediate/severe HHcy. OBJECTIVE : To evaluate the influence of intermediate (30–100 μmol/L) and severe (> 100 μmol/L) HHcy related to vitamin deficiencies and/or inherited disorders on CVD outcomes. DESIGN: We carried out a retrospective cross-sectional study on consecutive patients who nderwent a homocysteine assay in a French University Regional Hospital Center. Patients wth CVD outcomes were assessed for vitamin B12, folate, Hcy, methylmalonic acid, and ext-generation clinical exome sequencing. RESULTS: We report 165 patients hospitalized for thromboembolic and other cardiovascular anifestations among 1006 patients consecutively recruited. Among them, 84% (138/165) ad Hcy >30 μmol/L and 27% Hcy >50 μmol/L (44/165). HHcy was related to a deficiency in itamin B12 and/or folate in nearly 55% (87/165), mutations in one or more genes of onecarbon nd/or vitamin B12 metabolisms in 11% (19/165), and renal failure in 26% (44/165) f the studied patients. HHcy was the single vascular risk retrieved in almost 9% (15/165) of atients. 60% (101/165) of patients received a supplementation to treat HHcy, with a ignificant decrease in median Hcy from 41 to 17 μmol/L. No recurrence of thromboembolic anifestations was observed after treatment of patients with HHcy as singe risk, after nearly 4-years follow-up. CONCLUSION: The high frequency of intermediate/severe HHcy differs from the moderate HHcy reported in previous observational studies of patients with pre-existing CVD. Our study points out the importance of diagnosing and treating nutritional deficiencies and inherited disorders to reverse intermediate/severe HHcy associated with CV outcomes.
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Dates and versions

hal-03805931 , version 1 (07-10-2022)

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  • HAL Id : hal-03805931 , version 1

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Julien Lévy. Intérêt de l’homocystéine dans l’évaluation du risque cardiovasculaire au CHRU de Nancy. Médecine humaine et pathologie. 2020. ⟨hal-03805931⟩
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