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Total serum homocysteine - a predictor of extracranial carotid artery stenosis in male patients with symptomatic peripheral arterial disease

Department of Laboratory Medicine, University of Linz, Linz, Austria

Bernhard Furtmueller

Department of Surgery (Division of Vascular Surgery), University of Linz, Linz, Austria

Johannes Aigelsdorfer

Department of Surgery (Division of Vascular Surgery), University of Linz, Linz, Austria

Christian Luft

Departmentof Radiology, Konventhospital Barmherzige Brueder Linz, University of Linz, Linz, Austria

Werner Poelz

Department of Applied System Sciences and Statistics, University of Linz, Linz, Austria

Meinhard Haltmayer

Department of Laboratory Medicine, University of Linz, Linz, Austria, meinhard.haltmayer{at}bblinz.at

High total serum homocysteine (tHcy) concentrations are associated with an increased risk of carotid artery disease in the general population. Since patients with peripheral arterial disease (PAD) have a threefold risk of cerebrovascular morbidity compared to individuals free of PAD, and since the total neurological event rate is associated with a 50% lumen reduction in extracranial carotid arteries, it was tested whether tHcy is a predictor of internal carotid artery stenosis in patients with symptomatic PAD. A total of 443 consecutive male PAD patients without previous carotid surgery/stenting were studied. In all, 100 patients with PAD had an internal carotid artery stenosis 50%. Of the remaining 343 patients, 100 individuals matched for age (±2 years) and diabetes served as controls. The extent of carotid stenosis was evaluated with color duplex measurement; tHcy was determined by high-performance liquid chromatography. Cases displayed a significantly higher median fasting tHcy level (17.0 µmol/l) than controls (13.7 µmol/l, p = 0.001). Multivariate analysis showed that tHcy (p = 0.036) was an independent predictor of internal carotid artery stenosis 50% in PAD patients, representing an odds ratio of 1.32 (95% CI, 1.02-1.72) for an increment of 5 µmol/l. In the present study, high tHcy was an independent risk factor for an internal carotid artery stenosis 50% in patients with PAD. Since PAD patients suffer a threefold risk of stroke compared to healthy individuals, a simple vitamin substitution in PAD patients may reduce the occurrence of internal carotid artery stenosis and therefore diminish the relatively high rate of cerebrovascular events in this population.

Key Words: atherosclerosis • carotid stenosis • homocysteine • peripheral arterial disease • risk factors

Vascular Medicine, Vol. 6, No. 3, 163-167 (2001)
DOI: 10.1177/1358836X0100600307


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