Homocysteine and markers of inflammation in acute coronary syndrome

BACKGROUND: An elevated level of homocysteine (Hcy) has been shown to be a cardiovascular risk factor in the majority of research studies. Recently, it was found to be associated with new risk factors such as inflammatory markers. OBJECTIVES: To investigate the distribution of plasma total Hcy (tHcy) and the levels of inflammatory markers in patients with acute coronary syndrome (ACS), and to evaluate the association between these parameters and the severity of the disease. methods: A total of 122 patients with ACS and 80 control subjects were recruited from the cardiac intensive care unit of the Military Hospital of Tunis, Tunisia. Lipid profile and the levels of tHcy, high-sensitivity C-reactive protein (HsCRP), interleukin (IL)-6, IL-8, IL-1 beta and tumour necrosis factor-alpha (TNF alpha) were determined for all participants. The distribution of these parameters were compared between groups and according to the number of diseased vessels in patients with ACS. RESULTS: ACS patients had significantly elevated levels of tHcy (P<0.01), HsCRP (P<0.001), IL-6 (P<0.001), TNF alpha (P<0.001), folates (P<0.05) and vitamin B-12 (P<0.001), but lower high-density lipoprotein cholesterol (P<0.05) levels. The analysis of the association between these parameters and the number of diseased vessels showed significant differences in tHcy, HsCRP, IL-6 and TNF alpha, with positive correlations. Significantly negative correlations were found between the number of diseased vessels and folate (r=-0.34; P<0.01), and vitamin B-12 (r=-0.22; P<0.01). CONCLUSION: Elevated levels of tHcy, IL-6, TNF alpha and HsCRP appear to be associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease.