HDCN Article Review/Hyperlink

Petri M, Roubenoff R, Dallal GE, Nadeau MR, Selhub J, Rosenberg IH

Plasma homocysteine as a risk factor for atheroembolic events in systemic lupus erythematosus

Lancet (Oct) 348:1120-1123 1996

Apart from familial homocysteinemia, where the association between elevated plasma levels of homocysteins and premature atherosclerosis is clear, there is mounting evidence that mildly elevated homocysteine levels are associated with incresed risk of coronary artery disease, stroke, and carotid artery disease. In this study 337 relatively young (mean age 35) patients with lupus were followed for a mean of about 5 years. Blood samples were taken at study entry for homocysteine, vitamin B12, folate, and pyridoxal 5'-phosphate.

Raised homocystine levels (> 14 uM), which were found in 15% of the SLE patients increased the odds ratio of stroke to 2.24 and of arterial thrombotic events to 3.74. The increased risk persisted after adjusting for comorbid conditions. The risk of venous thrombosis was not increased.

Comment: As there were 60 cases of stroke or arterial thrombosis among 337 relatively young patients over a moderately short follow-up period, it seems attractive to pay special attention to the plasma homocysteine levels of patients with lupus. Whether correction or improvement of plasma homocysteine levels with supplemental folate is of benefit in such patients remains to be determined. The authors claim that a vitamin intervention study is in progress. (John T. Daugirdas, M.D., University of Illinois at Chicago)