Homocysteine in Chronic Heart Failure

Abstract

Background: Hyperhomocysteinemia (HHcy) is a risk factor for cardiovascular disease. Homocysteine (Hcy) can generate reactive oxygen species. Oxidative stress enhances the progression of cardiovascular diseases and has long been implicated in chronic heart failure (CHF). This study was to evaluate the predictive value of plasma Hcy levels in CHF patients and to investigate the relationship with other markers.

Methods: We investigated 134 adult CHF patients (males, 74%; mean age, 60.0 ± 14.8 years). Echocardiography, 6-min walk test, and determination of peak oxygen consumption (VO(2max)) were performed. Serum levels of Hcy and other markers were determined. Clinical follow-up was performed at five years.

Results: The mean Hcy level was markedly elevated in CHF patients (18.4 ± 7.83 μmol/L) vs. control subjects (12.8 ± 3.14 μmol/L; p < 0.01), whatever the etiology of heart failure (non-ischemic, n = 74, 17.6 ± 7.8 μmol/L; ischemic, n = 60, 19.3 ± 7.8 μmol/L). Hcy correlated negatively with VO(2max) and positively with BNP. Kaplan-Meier analysis showed that CHF patients with HHcy > 15 μmol/L had a significantly lower survival rate (35% vs. 56%, log-rank p < 0.05) than those without HHcy. Cox regression revealed that HHcy and hs-CRP were the most powerful independent predictors of mortality in patients at 5 years.

Conclusions: HHcy is common in CHF patients and is associated with an increased risk of death at 5 years. We suggest that Hcy can be used in clinical practice as an additional risk marker in CHF patients with various medications.