about 50% on infarct patients do not have overt hyperlipidemia. thus
one is on the lookout for a novel marker of atherogenesis. homocystein is
one such novel
marker. however multiple studies have shown that homocystein is not in
fact a risk factor for coronary artery disease. using prospective studies,
ascertaining
homocystein levels before the start of study found no relationship
between homocystein levels and vascular risk. it is perhaps the reason why
this study did not
reveal any difference in mortality based on B12 AND FOLATES levels.
an interesting observation is whereas Europeans tend to be
deficient in folate, Indians are cobalamine deficient as shown by one
study. it is not known if this study can be extrapolated to whole of
india. earlier it was beleived that risk to coronary artery disease is
limited to those with modest to high elevations of homocystein
levels.however, the lack of compelling evidence, make it uneconomical to
screen these patients for homocystein. also there does not appear to be a
case for dietary supplements en masse. mutation in the methylene
tetrahydrofolate reductase gene (mthfr) which leads to severe elevations
of homocystein have failed to show any association of ischaemic heart
disease in these group.from a genetic perspective, it is not useful to
screen these patients for homocystein. other conditions which lead to
elevation of homocystein are renal failure, hypothyroidism,and
carbamazepine and methotrexate use. in none of these conditions have there
been any association to coronary artery disease.in usa, food is fortified
with folates to reduce incidence of neural tube defects. this has lead to
a fall of homocystein levels in the population by a mean of 10%. also the
there has been a drop by 50% in those patients having a modest elevation
of homocystein of 150umol/l.(i.e high risk patients).thus screening for
homocystein in these patients is not warranted.
this brings to question the very high incidence of coronary artery disease
among young male indians.earlier it was postulated that high levels of
homcystein levels
may be a cause. high values of lipoprotein"a" was another. indian practice
of chewing tobacco (called gutka) may be contributing.
Rapid Response:
homocystein not a coronary risk factor
about 50% on infarct patients do not have overt hyperlipidemia. thus
one is on the lookout for a novel marker of atherogenesis. homocystein is
one such novel
marker. however multiple studies have shown that homocystein is not in
fact a risk factor for coronary artery disease. using prospective studies,
ascertaining
homocystein levels before the start of study found no relationship
between homocystein levels and vascular risk. it is perhaps the reason why
this study did not
reveal any difference in mortality based on B12 AND FOLATES levels.
an interesting observation is whereas Europeans tend to be
deficient in folate, Indians are cobalamine deficient as shown by one
study. it is not known if this study can be extrapolated to whole of
india. earlier it was beleived that risk to coronary artery disease is
limited to those with modest to high elevations of homocystein
levels.however, the lack of compelling evidence, make it uneconomical to
screen these patients for homocystein. also there does not appear to be a
case for dietary supplements en masse. mutation in the methylene
tetrahydrofolate reductase gene (mthfr) which leads to severe elevations
of homocystein have failed to show any association of ischaemic heart
disease in these group.from a genetic perspective, it is not useful to
screen these patients for homocystein. other conditions which lead to
elevation of homocystein are renal failure, hypothyroidism,and
carbamazepine and methotrexate use. in none of these conditions have there
been any association to coronary artery disease.in usa, food is fortified
with folates to reduce incidence of neural tube defects. this has lead to
a fall of homocystein levels in the population by a mean of 10%. also the
there has been a drop by 50% in those patients having a modest elevation
of homocystein of 150umol/l.(i.e high risk patients).thus screening for
homocystein in these patients is not warranted.
this brings to question the very high incidence of coronary artery disease
among young male indians.earlier it was postulated that high levels of
homcystein levels
may be a cause. high values of lipoprotein"a" was another. indian practice
of chewing tobacco (called gutka) may be contributing.
Competing interests:
None declared
Competing interests: No competing interests