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Homocyst(e)ine and Cardiovascular Disease
John W. Eikelboom, MBBS, FRACP;
Eva Lonn, MD, FRCPC; and
Salim Yusuf, MBBS, DPhil, FRCPC
18 April 2000 | Volume 132 Issue 8 | Page 676
IN RESPONSE:
To our knowledge, incidence of cardiovascular disease in patients with pernicious anemia has not been specifically examined. However, although folate is the most important determinant of plasma homocyst(e)ine, there is clearly also an inverse relation between cobalamin and plasma homocyst(e)ine (1). Pernicious anemia is the most common cause of cobalamin deficiency (2), and because the plasma homocyst(e)ine level is elevated in more than 95% of patients with pernicious anemia (3), an increased risk for cardiovascular disease might reasonably be expected in patients with pernicious anemia if an elevated homocyst(e)ine level is truly causally associated with an increased risk for cardiovascular disease. However, the causal nature of this association remains to be confirmed.
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Author and Article Information
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McMaster University; Hamilton, Ontario L8L 2X2, Canada (Eikelboom)
McMaster University; Hamilton, Ontario L8L 2X2, Canada (Lonn)
McMaster University; Hamilton, Ontario L8L 2X2, Canada (Yusuf)
1. Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population JAMA. 1993;270:2693-8.[Abstract]
2. Toh BH, van Driel IR, Gleeson PA. Pernicious anemia N Engl J Med. 1997;20:1441-8.
3. Savage DG, Lindebaum J, Stabler SP, Allen RH. Sensitivity of methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies Am J Med. 1994;96:239-46.[Medline]
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Reviews
Homocyst(e)ine and Cardiovascular Disease: A Critical Review of the Epidemiologic Evidence
John W. Eikelboom, Eva Lonn, Jacques Genest, Jr., Graeme Hankey, AND Salim Yusuf
- Annals 1999 131: 363-375.
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