Second Propedeutic Department of Internal Medicine, Medical School, Aristotle; University of Thessaloniki, Hippocration Hospital, Thessaloniki. Greece.
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/ University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid. Spain.
Curr Pharm Des. 2017;23(22):3224-3232. doi: 10.2174/1381612823666170317124913.
Elevated homocysteine (Hcy) levels are predictors of cardiovascular disease (CVD). Hyperhomocysteinemia has also been associated with total and CVD mortality. However, whether Hcy is just a marker or plays a causal role in CVD remains to be elucidated. In this narrative review, we discuss the associations between Hcy and non-cardiac vascular diseases, namely stroke, peripheral artery disease (PAD), carotid artery disease, chronic kidney disease (CKD), atherosclerotic renal artery stenosis (ARAS), abdominal aortic aneurysm (AAA) and erectile dysfunction (ED). The effects of several drugs on Hcy levels are also considered. Folic acid, vitamin B6 and B12 supplementation can significantly decrease circulating Hcy concentrations but their effects on CVD risk reduction are conflicting. No current guidelines recommend the routine screening of Hcy levels in patients with non-cardiac vascular diseases. Therefore, further research is needed to elucidate the use of Hcy in the clinical practice.
同型半胱氨酸（Hcy）水平升高是心血管疾病（CVD）的预测因子。高同型半胱氨酸血症也与全因死亡率和 CVD 死亡率相关。然而，Hcy 是否仅仅是一个标志物，或者在 CVD 中是否发挥因果作用仍有待阐明。在这篇叙述性综述中，我们讨论了 Hcy 与非心脏血管疾病之间的关系，即中风、外周动脉疾病（PAD）、颈动脉疾病、慢性肾脏病（CKD）、动脉粥样硬化性肾动脉狭窄（ARAS）、腹主动脉瘤（AAA）和勃起功能障碍（ED）。我们还考虑了几种药物对 Hcy 水平的影响。叶酸、维生素 B6 和 B12 补充剂可显著降低循环 Hcy 浓度，但它们对降低 CVD 风险的影响存在争议。目前没有指南建议对非心脏血管疾病患者常规筛查 Hcy 水平。因此，需要进一步研究阐明 Hcy 在临床实践中的应用。
