gms | German Medical Science

Objective: Hyperhomocysteinemia and homocysteine-induced endothelial dysfunction are thought to play an important role in the pathogenesis of vascular atherogenic propensity affecting vasoregulation, cell proliferation, platelet aggregation and leucocyte recruitment and adhesion. We investigated the association between soluble adhesions molecules (sVCAM-1, sICAM-1, sL-Selectin), homocysteine and the occurence of coronary heart disease (CHD) in hypertensive patients.

Patients/Methods: Only hypertensives without diabetes and with normal renal function were included. All 84 patients were diagnosed by cardiac catheterization. Measurements of soluble adhesions molecules (sVCAM-1, sICAM-1 Beckmann Coulter GmbH, sL-Selectin R&D Systems) were performed with enzyme immuno assays. Homocysteine concentration was measured by HPLC (Recipe GmbH). Furthermore, in a subgroup of 43 patients, other risk factors for CHD such as oxidized LDL (Immundiagnostik AG), lipoproteine (a) and von Willebrand factor were determined.

Results: CHD was seen in 44 (30 male, 14 female) and absent in 40 (19 male, 21 female) patients. Mean plasma concentrations of all adhesions molecules investigated were not significantly different between the groups. Homocysteine concentration was significantly higher in patients with CHD (17.4±14.1 µmol/l) than in those without CHD (14.9±6.8 µmol/l, p=0.04). In 19 patients with CHD, Lp(a) was significantly increased compared to 24 patients without CHD (339.5±346.9 vs. 183.2±164.7 mg/l, p=0.006). The same was true for the von Willebrand factor (with CHD 196.1±56.1; without CHD 160.7±52.1 %). Mean concentration of oxidized LDL did not show any significant differences between the groups (with CHD 14.9±4.6; without CHD 15.7±4.0 mU/l).

Conclusion: In non diabetic hypertensives with normal renal function an increased endothelial activity in correlation to CHD was not found, but an elevated homocysteine level seems to be a risk factor for CHD.