SESSION TYPE: CAD/Coronary Syndromes Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Elevated homocysteine levles are associated with impaired nitric oxide-mediated relaxation of the arterial vessel and increased smooth muscle cell proliferation. Production of uric acid by the catalytic oxidation of xanthine produces endothelium damaging superoxide radicals. These actions are injurious to the vascular endothelium and promote atherosclerosis. Homocysteinemia and hyperuricemia are both independently associated with increased cardiovascular disease. This study looks at their combined elevation in a hypertensive population.
METHODS: We reviewed the charts of consecutive hypertensive patients seen in the office over a 2 month period. We found 210 hypertensive patients who had uric acid, homocysteine, folate and vitamin B12 levels measured. Uric acid was high if it was 7 mg/dl or more while homocysteine was high if it was 15 Umol/L or more. Folate levels were considered normal between 5.4-24.0 ng/ml and vitamin B12 levels normal between 211-911 pg/ml. Blood testing was done by a commercial laboratory.
RESULTS: Of the 210 patients, 30 had elevated homocysteine and 44 had elevated uric acid levels. Of the 30 with elevateed homocysteine levels 13 (43%) had elevated uric acide levels while of the 180 with normal homocysteine levels, 31 (17%) had elevated uric acid levels. Of the 44 with elevated uric acid levles, 13 (30%) had elevated homocystein levels while of the 166 with no hyperuricemia, 31 (19%) had elevated homocysteine levels. Folic acid and vitamin D levels were normal in both groups.
CONCLUSIONS: Our study finds that hyperhomocysteinemia and hyperuricemia frequently coexist in hypertensive patients. This combination may be highly atherogenic. It is not clear if the therapeutic reduction of these levels result in better cardiovascular outcomes. However, till further studies are available, treatment with allopurinol and or supplemental vitamin B6, vitamin B12 or folic acid may be considered in this high risk subgroup.
CLINICAL IMPLICATIONS: Hyperuricemia and homocysteinemia frequently coexist in hypertensives. This subgroup may be at a higher risk of atherogenesis.
DISCLOSURE: The following authors have nothing to disclose: Shashi Agarwal
No Product/Research Disclosure InformationAgarwal Health Center, East Orange, NJ