In the World Heart Day (29 September) established in 2000 by the World Health Federation (WHF), we would like to recall the importance of prevention in reducing the incidence of cardiovascular diseases, which cause 18.6 million of deaths every year.
For the 21st anniversary, the Italian Federation for the Heart (FIPC) promotes the claim “USE HEART FOR EVERY HEART”. This slogan underlines how much each of us can do for the health of our heart and to prevent cardiovascular diseases, making healthy choices for ourselves and our loved ones, for society and the sustainability of the environment.
In this regard, we can act by modifying some of the most common risk factors of these pathologies that the WHO identifies in physical inactivity, tobacco, and alcohol abuse, and an unbalanced diet.
Several scientific evidences shown that hyperhomocysteinemia is also a cardiovascular risk factor not to be underestimated [1,2]
What is homocysteine?
Homocysteine is an aminothiol not present in proteins. It is a secondary product obtained from the metabolism of methionine and an essential sulfur amino acid introduced into our body with the diet.
The regulation of homocysteine metabolism is based on the activity of enzymes and vitamins such as B6, B9 (or folic acid) and B12. A deficiency in them can lead to a reduction in its metabolism with consequent plasma accumulation.
We talk about hyperhomocysteinemia when…
Hyperhomocysteinemia consists in an elevated levels of homocysteine in the blood.
A value of 13 μmol/l is considered by WHO (World Health Organization) a normal blood value. Therefore, we speak of high levels of homocysteine when measuring in the blood concentrations:
- higher than 13 μmol/l in adult men,
- higher than 10.1 μmol/l for women,
- above 11.3 μmol/l in children under the age of 14.
What are the causes?
The causes of hyperhomocysteinemia can be distinguished into congenital and acquired. Among the congenital causes, deficiencies of enzymes involved in reactions concerning the metabolism of homocysteine, such as MTHFR , are recognized.
While among the acquired causes are identified: nutritional deficiencies (for example B vitamins), menopause, drugs (anticonvulsants, estrogens) and pathologies such as liver and kidney failure.
Hyperhomocysteinemia and cardiovascular risk
Several studies highlight those high levels of homocysteine in the blood lead to: endothelial reduction of nitric oxide (NO), increased blood clotting, increased risk of thrombus formation, endothelial damage, and dysfunction as well as an increase in oxidative stress [3-6]. Given the importance of these events in the onset of cardiovascular diseases, the control of homocysteine levels in the blood is a real act of protection towards the health of our heart, in line with the claim “USE HEART FOR EVERY HEART”.
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 Cattaneo, Marco (1999). Hyperhomocysteinemia, Atherosclerosis and Thrombosis. Thrombosis and Haemostasis, 81(2), 165–176.
 Utpal Sen et al., (2010). Homocysteine to Hydrogen Sulfide or Hypertension, 57(2-3), 49–58.
 Clarke R et al., Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 1991; 324:1149-55;
 Hankey GJ et al., Homocysteine and vascular disease. Lancet 1999; 354:407-413.;
 Varga E.A et al., Homocysteine and MTHFR Mutations. Relation to Thrombosis and Coronary Artery Disease. Circulation 2005;111: e289-e293;
 De Caterina R et al., New cardiovascular risk factors: homocysteine and vitamins involved in homocysteine metabolism. Ital Heart J 2004;5 (Suppl 6):19s-24s.