This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van der Griend, R. Articles by Banga, J.-D. Search for Related Content PubMed PubMed Citation Articles by van der Griend, R. Articles by Banga, J.-D. Social Bookmarking                   What's this?

Postmethionine-load homocysteine determination for the diagnosis hyperhomocysteinaemia and efficacy of homocysteine lowering treatment regimens

Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands, RvdGriendKdiakhuis.nl

Douwe H Biesma

Department of Sint Antonius Hospital, Nieuwegein, The Netherlands

Jan-Dirk Banga

Department of University Medical Center Utrecht, The Netherlands

Substantial epidemiological evidence supports the vision that moderate hyperhomocysteinaemia is a graded and independent cardiovascular risk factor. The additional value of the methionine loading test for the assessment of hyperhomocysteinaemiacontinues to be disputed.

This overview presents the historical background for the rationale of the methionine loading test and describes determinants and variability of the postmethionine-load homocysteine concentration. The association of postmethionine-load homocysteine concentrations and the risk of cardiovascular events is discussed. Furthermore, the results of homocysteine lowering treatment on postmethionine-load homocysteine are given.

Up to 50% of subjects with hyperhomocysteinaemia can only be detected after performing a methionine loading test; these subjects have a normal fasting homocysteine. Both fasting and postmethionine-load homocysteine concentrations are influenced by serum folate and creatinine concentrations and by the methylenetetrahydrofolate reductase genotype, and may be subject to a wide intra-individual variability (20%).

Cross-sectional studies suggest that cardiovascular risk may increase gradually from post-methionine-load homocysteine concentrations above 38 m mol/l. Supplementation with folic acid 0.5 mg daily adequately reduces postmethionine-load homocysteine; addition of pyridoxine appears to have no further homocysteine lowering effect.

Prospective studies supporting the clinical significance of the methionine loading test for individual patient counselling are lacking; it seems, therefore, prudent to restrict this test for research purposes.

Key Words: folic acid • homocysteine • hyperhomocysteinaemia • methionine loading test • pyridoxine

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				T. Guttuso, M. P. McDermott, H. Su, and K. Kieburtz Effects of L-Isoleucine and L-Valine on Hot Flushes and Serum Homocysteine: A Randomized Controlled Trial Obstet. Gynecol., July 1, 2008; 112(1): 109 - 115. [Abstract] [Full Text] [PDF]

				P. I. Holm, P. M. Ueland, S. E. Vollset, O. Midttun, H. J. Blom, M. B.A.J. Keijzer, and M. den Heijer Betaine and Folate Status as Cooperative Determinants of Plasma Homocysteine in Humans Arterioscler. Thromb. Vasc. Biol., February 1, 2005; 25(2): 379 - 385. [Abstract] [Full Text] [PDF]

				O. Bleie, H. Refsum, P. M. Ueland, S. E. Vollset, A. B. Guttormsen, E. Nexo, J. Schneede, J. E. Nordrehaug, and O. Nygard Changes in basal and postmethionine load concentrations of total homocysteine and cystathionine after B vitamin intervention Am. J. Clinical Nutrition, September 1, 2004; 80(3): 641 - 648. [Abstract] [Full Text] [PDF]

				P. Vallance and J. Leiper Cardiovascular Biology of the Asymmetric Dimethylarginine:Dimethylarginine Dimethylaminohydrolase Pathway Arterioscler. Thromb. Vasc. Biol., June 1, 2004; 24(6): 1023 - 1030. [Abstract] [Full Text] [PDF]

				H. Refsum, A. D. Smith, P. M. Ueland, E. Nexo, R. Clarke, J. McPartlin, C. Johnston, F. Engbaek, J. Schneede, C. McPartlin, et al. Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion Clin. Chem., January 1, 2004; 50(1): 3 - 32. [Abstract] [Full Text] [PDF]