Homocysteine levels and peripheral arterial occlusive disease: a prospective cohort study and review of the literature.
The aim of this study was to determine the prevalence of hyperhomocysteinemia in a population with peripheral vascular occlusive disease in Kuwait. From November 2000 to May 2002, total serum homocysteine levels were measured in 172 consecutive patients admitted to the vascular surgery unit because of peripheral vascular arterial disease. A fluorescence polarization immunoassay was used for measuring total serum homocysteine levels. Serum homocysteine levels over 15 mol/L were considered as high. The mean ankle-brachial index was 0.59+/-0.2 and 0.55+/-0.2 for right and left legs, respectively. The mean serum homocysteine level was 14.9+/-4.7 mol/L (range, 4.2-50.0). High homocysteine levels were found in 70 out of 172 patients (40.7%). The prevalence of hyperhomocysteinemia was significant in patients with hypertension (P=0.03) and ischaemic heart disease (P=0.04). Binary logistic regression model showed that male gender, diabetes mellitus and hypertension were significant independent predictors for high levels of homocystinemia in peripheral vascular occlusive disease [adjusted odds ratio (OR) 2.90; 95% confidence interval (CI); 1.18-7.12; P=0.02]; [0.35 OR; 95% CI; 0.15-0.79; P=0.01] and [2.12 OR; 95% CI; 0.98-4.59; P=0.05], respectively. Diabetes was significant but appeared to protect for peripheral vascular occlusive disease in patients with high levels of serum homocysteine. Elevated homocysteinemia was found in 40.7% of patients suffering from peripheral vascular disease. In this cohort, male gender, diabetes and hypertension were found to be risk factors along with elevated homocysteine levels.