HOMOCYSTEIN AS A RISK FACTOR IN THE PATIENTS SUFFERING FROM TYPE 2 DIABETES MELLITUS-ASSOCIATED CORONARY ARTERY DISEASE

HOMOCYSTEIN AS A RISK FACTOR IN THE PATIENTS SUFFERING FROM TYPE 2 DIABETES MELLITUS-ASSOCIATED CORONARY ARTERY DISEASE

Mammetberdi Elyasov

Candidate of Medical Science Head of the medical science division, The Academy of Sciences of Turkmenistan,

Turkmenistan, Ashgabat

ABSTRACT

Hyperhomocisteinemia as an independent factor of thrombogenic risk and as a factor of progression of arterial sclerotic disease in the patients suffering from CAD and type 2 DM is observed in more than 43.3% cases. The older the patients the more the number of cases with hyperhomocisteinemia occurs, and specifically its averages rise.

Keywords: hyperhomocisteinemia, homocystein, coronary artery disease, diabetes mellitus, syndrome.

It is known that metabolism of homocystein comes in two ways: remethylation and transformation with the active participation of folate- and cobalamin-dependent enzymes either due to heterozygous carriage of abnormal genes or latent vitamin deficiency. Besides, blood homocystein level is influenced by age, smoking, alcohol, coffee and some medications [3, 6]. Studies conducted in the past years showed possible participation of homocystein in occurrence and progression of age-related mental disability, Alzheimer disease [1].

Thrombophilic condition under hyperhomocisteinemia is formed due to vascular disease caused by homocystein’s direct toxic effect on endothelium and indirect effect through stimulation of proliferation of vascular smooth muscle cells, activation of platelet aggression, disturbance of thrombolysis. Although the significance of hyperhomocisteinemia in genesis of progression of atherosclerosis and vascular thrombosis has been discussed in the literature, there are only single reports about such pathology [6, 9]. According to some reports, hyperhomocisteinemia is observed in more than 50% patients with CAD and in almost the same amount of peoples with type II DM [1, 2, 5, 6].

Purpose of the study – determination of frequency of hyperhomocisteinemia and its severity in the patients suffering from coronary artery disease and type II diabetes mellitus.

83 patients with various forms of progress of coronary artery disease and type II diabetes mellitus were examined. All patients passed through angiographic study which revealed coronary artery stenosis. The average age of the patients was 56.2±3.0, of whom 62 were men and 21 were women.

All the patients were separated into three groups: 1^st group included 20 (34.9%) patients suffering from CAD with stable angina, 2^nd group included 22 (26.5%) patients suffering from acute myocardial infarction with Q wave, and 3^rd group included 32 (38.6%) patients suffering from acute coronary syndrome. The control group included 17 apparently healthy people aged 49.2±1.3. The homocystein level was determined in blood serum by the immunoenzyme method using diagnostics instruments of AXIS company (Norway). Statistical processing of the obtained results was conducted using Statistica 6.0 application (StatSoft, Inc. 2001). Averages (M) are given in respect to standard deviation (SD).  The results obtained at < 0.05 are considered statistically significant.

Results and their discussion. The homocystein level in blood serum of healthy people averaged to 9.6±0.32 µmol/l (diagram 1).

Diagram 1. The homocystein level in blood serum in the patients with CAD and type 2 DM

The homocystein level in the patients group was significantly higher than in the control group and averaged to 14.8±0.12 µmol/l (p<0.05). Only in 36 (43.4%) of the examined patients the specified indicator was within normal limits, while in 47 patients (56.6%) it was increased: in 28 (33.7%) - moderate increase; in19 (22.9%) - significant increase.

In the patients with Q-wave acute myocardial infarction, the homocystein level amounted to 13.4±1.3 µmol/l (p<0.05), in the patients with acute coronary syndrome - 16.8±1.7 µmol/l (p<0.05), and in the patients with stable progress of CAD - 12.1±0.51 µmol/l (p<0.05) in comparison with the control group. Statistical processing of the homocystein concentration depending on gender differences was not performed due to few female patients. However, hyperhomocisteinemia in males was observed in 34 (41.0%) cases, while in females - in 9 (10.8%) cases. Some researchers note higher homocystein content in males, than in the female ones, but the difference is leveled out after climax [5, 10]. It is possible that the gender differences at this point are partially related to the fact that the males smoke more often (according to our data: 24.1% of cases with smoking history of more than 20 years) and more often drink alcoholic beverages. According to our data this facilitates formation of hypovitaminosis and hyperhomocisteinemia [7, 11].

When comparing the group of patients suffering from CAD, type 2 DM and stable angina and the group of patients with symptoms of acute coronary syndrome, significant differences on the blood homocystein level were observed. However, in the patients in whom Q-wave acute myocardial infarction was diagnosed, no significant difference on the on the blood homocystein level was observed. Number of patients and severity of hyperhomocisteinemia are increased with aging (p<0.05) (diagram 2).

Diagram 2. Dependence of the homocystein level on age

Therefore, hyperhomocisteinemia as an independent factor of thrombogenic risk and as a factor of progression of arterial sclerotic disease in the patients suffering from CAD and type 2 DM is observed in more than 43.3% cases. The older the patients the more the number of cases with hyperhomocisteinemia occurs, and specifically its averages rise.

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