Wierzbicki Anthony S
St Thomas' Hospital, Lambeth Palace Road, London, UK.
Diab Vasc Dis Res. 2007 Jun;4(2):143-50. doi: 10.3132/dvdr.2007.033.
Elevated homocysteine (HCY) levels can be caused by a number of factors, including folate and B-vitamin deficiency, pre-existing atherosclerotic disease, diabetes and various drugs. Epidemiological evidence, as well as data from retrospective and prospective studies, supports an association between elevated HCY levels and increased risk of cardiovascular disease (CVD). However, whether lowering HCY levels by administration of folate and vitamins B6 and B12 is associated with any significant decrease in vascular risk remains the subject of ongoing debate. Although the major studies that have reported to date show that vitamin supplementation was associated with a decrease in HCY levels, this failed to have any significant effect on cardiovascular risk. Furthermore, although some lipid-modifying treatments have been shown to increase HCY levels, there is no evidence that this attenuates or compromises the beneficial effects of such treatments on cardiovascular risk. Taken together, these data suggest that HCY is a marker, rather than a cause, of CVD and therefore do not provide support for routine screening for and treatment of elevated HCY to prevent CVD. Data from ongoing clinical trials are awaited to clarify this issue.
同型半胱氨酸（HCY）水平升高可由多种因素引起，包括叶酸和B族维生素缺乏、已有的动脉粥样硬化疾病、糖尿病及各种药物。流行病学证据以及回顾性和前瞻性研究的数据均支持HCY水平升高与心血管疾病（CVD）风险增加之间存在关联。然而，通过补充叶酸、维生素B6和B12来降低HCY水平是否会显著降低血管风险仍是一个持续争论的话题。尽管迄今为止报道的主要研究表明补充维生素与HCY水平降低有关，但这对心血管风险并无显著影响。此外，尽管一些调脂治疗已被证明会使HCY水平升高，但没有证据表明这会减弱或损害此类治疗对心血管风险的有益作用。综合来看，这些数据表明HCY是CVD的一个标志物，而非病因，因此不支持为预防CVD而对升高的HCY进行常规筛查和治疗。有待正在进行的临床试验数据来阐明这一问题。
