Homocysteine

Homocysteine Dr Hussam elmouzi Clinical pathologist Alborg Laboratory The new cholesterol

The right idea but the wrong era ,[object Object],[object Object],[object Object]

Annual publication rates within the fields of homocysteine and folate http://www.ncbi.nlm.nih.gov/PubMed at present there is virtually a "new paper every day" on the subject

[object Object],[object Object],[object Object],[object Object],Epidemiology Annu Rev Med 1998;49:31-62. HCY and cardiovascular disease. Refsum H, Ueland PM, et.al. Jacques PF, Bostom AG, Wilson PW, et.al. Determinants of plasma total HCY concentration in the Framingham Offspring cohort. Am J Clin Nutr. 2001;73:613-621

Homocysteine metabolism Methionine Homocysteine Cysteine meat, eggs, milk, cheese, white flour, canned foods and highly processed foods. Methyl transferase ,[object Object],[object Object],Cystathionine synthase ,[object Object],Circulation. 1999;99:178-182

Increase homocysteine concentration Methionine Homocysteine Cysteine Methyl transferase Cystathionine synthase Genetics: altered enzyme activity of HCy related pathways 【 nutritional deficiencies, life style , drugs , some diseases 】 ,[object Object],Family history: of heart disease, stroke, cancr,Alezheimer’s disease, diabetes ,[object Object],[object Object]

Risk Factors for CVD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What Homocysteine Does to Arteries ,[object Object],[object Object],[object Object],[object Object],[object Object],（ Loscalzo et al., 1998;Maxwal., 2000 ）

Homocysteine vs. Cholesterol ,[object Object],[object Object],heart44; 11-01-2004

High Sensitivity C-Reactive Protein (hs-CRP) ,[object Object],[object Object],[object Object],2010 Cleveland Clinic .

Ranges of hs-CRP in prediction of risk for CVD are ,[object Object],[object Object],[object Object],[object Object]

FOUR WAYS FIBRINOGEN CAUSES HEART DISEASE ,[object Object],[object Object],[object Object],[object Object],Circulation. 2003 Jan 28;107(3):499-511 .

Lipoprotein (a) ,[object Object],[object Object],[object Object],2011 by American Association for Clinical Chemistry

[object Object],[object Object],[object Object],Homocysteine & Diabetes Vasc Health Risk Manag. 2010; 6: 327–332.

Homocysteine Levels May Be Related to Osteoporosis ,[object Object],[object Object],N Engl J Med. 2004;350:2033-2041

Homocysteine & Pregnancy Complication ,[object Object],[object Object],[object Object],[object Object]

[object Object],The Hordaland Homocysteine Study. JAMA 1995;274:1526–33

MTHFR deficiency ,[object Object],[object Object],[object Object],den Heijer M. J Thomb Haemost 2005;3:292-9

Homocysteine and Alzheimer's Disease ,[object Object],[object Object],[object Object],New England Journal of Medicine", 2002;346(7):466-468. :

CANCER – CUT YOUR RISK BY A THIRD ,[object Object],[object Object],Cancer Council Victoria 2011

HALVE YOUR RISK OF DEATH FROM ALL CAUSES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Homocysteine New studies ,[object Object],[object Object],[object Object],[object Object],Nutridisk 2011

How is the homocysteine level measured ? ,[object Object],[object Object],[object Object]

Should Hyperhomocysteinemia Be Treated? (Part 1) ,[object Object],[object Object],[object Object],[object Object],Coronary Heart Disease ,Homocysteine,heart disease and stroke 2008

Should Hyperhomocysteinemia Be Treated? (Part 2) ,[object Object],[object Object],[object Object],Coronary Heart Disease ,Homocysteine,heart disease and stroke 2008

Who should have their Homocysteine level tested?

How should be tested for hyperhomocysteinemia Other opinions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clin Chem Lab Med. 2001 Aug;39(8):666-74 .

Interpretation of Homocysteine Levels Plasma Total Homocysteine graded risk factor for cardiovascular disease (Clin Chem 2009; 55:378-84): Less than 11 µmol/L 11-14 µmol/L 15-29 µmol/L Greater than 29 µmol/L Desirable Intermediate High Very High

Homocysteine and Nutrition: The Vitamin Connection ,[object Object],[object Object],[object Object],Screening for vitamin B12 and folate deficiency in older persons. Am J Clin Nutr 2003; 77: 1241-7.

Vitamins and Food sources ,[object Object],[object Object],[object Object]

[object Object],[object Object],American Journal of Clinical Nutrition, Vol. 86, No. 5, 1563S-1568S, November 2007

RDA for Vitamins B6, B12 and Folate ,[object Object],[object Object],[object Object]

treatment of hyperhomocysteinemia Treatment of hyperhomocysteinemia ,[object Object]

Number of Homocysteine tests per year Alsalama Branch Year No. of Tests 2008 9 2009 43 2010 270

Homocysteine test results Alsalama Branch 2010 µmol/L 11 15 30 Desirable High Very High 40 % Intermediate

Take Home Message ,[object Object],[object Object],[object Object]

Prevention is always better than cure Thank You For your Attention

Homocysteine

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Homocysteine