TITLE

Drugs Affecting Homocysteine Metabolism: Impact on Cardiovascular Risk

AUTHOR(S)
Desouza, C.; Keebler, M.; McNamara, D.B.; Fonseca, V.
PUB. DATE
February 2002
SOURCE
Drugs;2002, Vol. 62 Issue 4, p605
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Elevated total plasma homocysteine has been established as an independent risk factor for thrombosis and cardiovascular disease. A strong relationship between plasma homocysteine levels and mortality has been reported in patients with angiographically confirmed coronary artery disease. Homocysteine is a thiol containing amino acid. It can be metabolised by different pathways, requiring various enzymes such as cystathionine β-synthase and methylenetetrahydrofolate reductase. These reactions also require several co-factors such as vitamin B6 and folate. Medications may interfere with these pathways leading to an alteration of plasma homocysteine levels. Several drugs have been shown to effect homocysteine levels. Some drugs frequently used in patients at risk of cardiovascular disease, such as the fibric acid derivatives used in certain dyslipidaemias and metformin in type 2 (non-insulin-dependent) diabetes mellitus, also raise plasma homocysteine levels. This elevation poses a theoretical risk of negating some of the benefits of these drugs. The mechanisms by which drugs alter plasma homocysteine levels vary. Drugs such as cholestyramine and metformin interfere with vitamin absorption from the gut. Interference with folate and homocysteine metabolism by methotrexate, nicotinic acid (niacin) and fibric acid derivatives, may lead to increased plasma homocysteine levels. Treatment with folate or vitamins B6 and B12 lowers plasma homocysteine levels effectively and is relatively inexpensive. Although it still remains to be demonstrated that lowering plasma homocysteine levels reduces cardiovascular morbidity, surrogate markers for cardiovascular disease have been shown to improve with treatment of hyperhomocystenaemia. Would drugs like metformin, fibric acid derivatives and nicotinic acid be more effective in lowering cardiovascular morbidity and mortality, if the accompanying hyperhomocysteinaemia is treated? The purpose of this review is to highlight the importance of homocysteine as a risk factor, and examine the role and implications of drug induced modulation of homocysteine metabolism.
ACCESSION #
6280835

 

Related Articles

  • Inflammation and Hypercoagulable State in Adult Psoriatic Men. Karabudak, Ozlem; Ulusoy, Rifat Eralp; Erikci, Alev Akyol; Solmazgul, Emrullah; Dugan, Bilal; Harmanyeri, Yavuz // Acta Dermato-Venereologica;2008, Vol. 88 Issue 4, p337 

    Hyperhomocysteinaemia is a well-known risk factor for cardiovascular disease and plays a role in atherothrombosis. Psoriasis is a common chronic and recurrent inflammatory skin disease associated with increased thrombosis. The aim of this study was to examine serum homocysteine levels and their...

  • Effect of genetic variation in the human S-adenosylhomocysteine hydrolase gene on total homocysteine concentrations and risk of recurrent venous thrombosis. Gellekink, Henkjan; Heijer, Martin den; Kluijtmans, Leo A J; Blom, Henk J // European Journal of Human Genetics;Nov2004, Vol. 12 Issue 11, p942 

    Hyperhomocysteinemia is an independent and graded risk factor for arterial vascular disease and venous thrombosis. It is still debated via which mechanism homocysteine (Hcy) causes vascular disease. S-adenosylhomocysteine hydrolase (AHCY) catalyses the reversible hydrolysis of...

  • Potential role for adenosine in the pathogenesis of the vascular complications of hyperhomocysteinemia Riksen, Niels P.; Rongen, Gerard A.; Blom, Henk J.; Russel, Frans G.M.; Boers, Godfried H.J.; Smits, Paul // Cardiovascular Research;Aug2003, Vol. 59 Issue 2, p271 

    Hyperhomocysteinemia is an independent risk factor for cardiovascular disease. Most previous investigations focused on the role of homocysteine as direct pathogenetic factor for these adverse vascular events. However, the exact pathophysiological mechanism is still unknown. In this review we...

  • Renal uptake and excretion of homocysteine in rats with acute hyperhomocysteinemia. House, James D.; Brosnan, Margaret E.; Brosnan, John T. // Kidney International;Nov1998, Vol. 54 Issue 5, p1601 

    Renal uptake and excretion of homocysteine in rats with acute hyperhomocysteinemia. Background. Elevated plasma total homocysteine, an independent risk factor for cardiovascular disease, is commonly observed in renal patients. We have previously shown that the kidney is a major site for the...

  • Homocysteine Levels and Cardiovascular Disease. Sadovsky, Richard // American Family Physician;2/15/2000, Vol. 61 Issue 4, p1183 

    Provides information on the study `Homocysteine and Cardiovascular Disease: A Critical Review of the Epidemiologic Evidence,' by J.W. Eikelboom and colleagues published in the September 7, 1999 issue of the `Annals of Internal Medicine.'

  • Homocysteine - modest risk factor for deep vein thrombosis and pulmonary embolism. Stoicescu, Claudiu // Maedica - a Journal of Clinical Medicine;2007, Vol. 2 Issue 2, p157 

    The article features the functionality of homocysteine, an amino acid used normally by the body in cellular metabolism and the manufacture of proteins. It cites that increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) associate high levels of homocysteine. It highlights the...

  • Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. Wald, David S; Law, Malcolm; Morris, Joan K // BMJ: British Medical Journal (International Edition);11/23/2002, Vol. 325 Issue 7374, p1202 

    Abstract Objective: To assess whether the association of serum homocysteine concentration with ischaemic heart disease, deep vein thrombosis and pulmonary embolism, and stroke is causal and, if so, to quantify the effect of homocysteine reduction in preventing them. Design: Meta-analyses of the...

  • IS THE RISK OF THROMBOSIS IN PERSONS WITH ANTIPHOSPHOLIPID ANTIBODIES (aPL) INCREASED WITH ABNORMAL ACTIVATED PROTEIN C RESISTANCE (APCR) OR HOMOCYSTEINE?  // Lupus;Jan2001 Supplement 1, Vol. 10, pS8 

    An abstract of the article "Is the Risk of Thrombosis in Persons with Antiphospholipid Antibodies (aPL) Increased with Abnormal Activated Protein C Resistance (APCR) or Homocysteine?" is presented. The study aims to determine whether the association of acquired activated protein C resistance or...

  • Thigh-length compression stocking did not reduce VTE after stroke.  // Hem/Onc Today;7/10/2009, Vol. 10 Issue 13, p26 

    The article discusses a study which examined whether the use of thigh-length graduated compression stockings can reduce the occurrence of symptomatic or asymptomatic deep vein thrombosis following stroke.

  • 5. Patients at risk of thrombosis. Provan, Drew // GP: General Practitioner;2/3/2003, p88 

    Focuses on patients suffering from thrombosis. Description of the disease; Need for investigation of patients with unusual or unexplained thrombosis; Coagulation studies on patients who developed arterial thrombosis under the age of 30.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics