Homocysteine, the New Marker of Disease Risk - An Overview

Homocysteine, the New Marker of Disease Risk - An Overview

Bolander-Gouaille Christina
European Pharmacotherapy 2005
Published: September 2005
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Is the Risk Factor Homocysteine Here to Stay?
There is hardly any doubt that homocysteine determination will become a tool used increasingly for risk assessment. At the same time it appears highly likely that current reference limits will evolve from being based statistically on values from a presumed healthy population, toward a more normative base where the norm is an optimal level. Current upper reference limits would then decrease (in the same way they have done for cholesterol). There is also likely to be a focus on lifestyle factors interacting with the homocysteine turnover and on oxidative interactions.

Results from on-going intervention trials involving over 70,000 subjects will hopefully indicate the extent to which lowering homocysteine levels will affect the occurrence, recurrence, or progression of potential homocysteine-related diseases; however, there is some concern about these studies. One reason is that folic acid fortification has been introduced in, for example, the US and Canada, which reduces the power of the studies. Furthermore, it is difficult to guarantee that these studies are really placebo-controlled, as patients have been informed about the possible effects of vitamins and lifestyle.

Another problem is that the duration of the studies may be too short. Attention was recently drawn to the fact that diseases associated with nutrient factors may develop over a very long period. Both shortand long-latency deficiency states of calcium and vitamin D have been demonstrated. 36 Some of the consequences of hyperhomocysteinemia may become apparent fairly soon, whereas for others it will be after a long latency period. This might be the reason why the association between homocysteine and morbidity was found to be far stronger in an elderly population than in a younger, in the Norwegian Hordaland Study. These considerations do not render homocysteine to be a less important risk marker, although it will be some time before its final role can be determined.

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