Serum homocysteine as a predictor of severity of peripheral arterial disease in association with Doppler ultrasonography

Authors

  • Preethi S. P. Department of Surgery, JSS Hospital and University, Mysore, Karnataka, India
  • Tejaswi Hemachandran Department of Surgery, JSS Hospital and University, Mysore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20195108

Keywords:

Homocysteine, Peripheral arterial disease, Peripheral vascular disease

Abstract

Background: To evaluate association between raised serum homocysteine levels and severity of peripheral vascular disease (PVD) and to assess the role of homocysteine as a prognostic marker in PVD and thereby aid in early referrals to prevent cerebral and coronary events in those patients and introduce homocysteine lowering with vitamin therapy as part of medical management in patients diagnosed with PVD.

Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the above values with Doppler ultrasonography (USG) in the duration between 2016-2018 (18 months).

Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum Hcy levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 66.7% predictability.

Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomised trials are required to elucidate its clinical relevance in PAD as a prognostic marker of severity. 

References

Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47:1239-312.

Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a metaanalysis. JAMA.2008; 300:197-208.

CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) Lancet. 1996;348:1329-39.

Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381-6.

Heald CL, Fowkes FG, Murray GD, Price JF, Ankle Brachial Index Collaboration. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atheroscl. 2006;189(1):61-9.

Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, et al. Atherosclerotic vascular disease conference: writing group I: epidemiology. Circulation. 2004;109(21):2605-12.

Suurkula M, Fagerberg B, Wendelhag I, Agewall S, Wikstrand J. Atherosclerotic disease in the femoral artery in hypertensive patients at high cardiovascular risk. The value of ultrasonographic assessment of intima-media thickness and plaque occurrence. Risk Intervention Study (RIS) Group. Arterioscler Thromb Vasc Biol. 1996;16:971-7.

Arnlov J, Pencina MJ, Amin S, Nam BH, Benjamin EJ, Murabito JM, et al. Endogenous sex hormones and cardiovascular disease incidence in men. Ann Intern Med. 2006;145: 176-84.

Anderson PL, Gelijns A, Moskowitz A, Arons R, Gupta L, Weinberg A, et al. Understanding trends in inpatient surgical volume: vascular interventions, 1980-2000. J Vasc Surg. 2004;39(6):1200-8.

Athyros VG, Mikhailidis DP, Papageorgiou AA, Didangelos TP, Ganotakis ES, Symeonidis AN, et al. Prevalence of atherosclerotic vascular disease among subjects with the metabolic syndrome with or without diabetes mellitus: the METS-GREECE Multicentre Study. Current Med Resea Opinion. 2004;20(11):1691-701.

Downloads

Published

2019-10-24

Issue

Section

Original Research Articles