Online ISSN: 2515-8260

Keywords : Homocysteine

Homocysteine as a risk factor in patients with acute vascular events

Achyut Kannawar, Dany John, Ramesh Kawade, Vijaysinh Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 4712-4716

Background: Acute arterial vascular events are the leading cause of premature death and disability in the developed world. The present study was conducted to assess homocysteine as a risk factor in patients with acute vascular events.
Materials & Methods: 74 patients of ischemic heart disease,peripheral vascular disease, deep vein thrombosis and pulmonary thromboembolism of both genders underwent estimation of fasting plasma homocysteine estimation was done by fluorescence polarization immunoassay. Symptoms and risk factors such as hypertension, smoking, alcohol, diabetes, BMI and family history was recorded.
Results: Out of 74 patients, males were 40 and females were 34. Symptoms such as chest pain was seen in 62, headache in 57, breathlessnessin 52 and palpitations in 40. Risk factors were hypertensionin 34, diabetesin 30, alcohol in 16, smoking in 23, dyslipidaemia in 65 and family h/o CADin 40. The difference was significant (P< 0.05).
Conclusion: Plasma homocysteine is an independent risk factor for the development of acute vascular event

Hyperhomocysteinemia in diabetic and/or hypertensive patients with CKD: A cross sectional study

Dr. Mohan CN, Dr. Arvind MN, Dr. Harsha V Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3657-3664

Background & Objectives: Chronic kidney disease (CKD) is a commonly seen clinical condition resulting from different etiologies, diabetes and hypertension contributing to majority of CKD. Hyperhomocysteinemia is observed in CKD, which contributes to increased cardiovascular morbidity and mortalities according to many studies. Reduction of homocysteine level may help to decrease the cardiovascular morbidity and mortality which are leading cause of death in CKD patients.
Material and Methods: 90 patients with diabetes and/or hypertension, diagnosed as CKD with eGFR <90ml/min visiting the hospitals attached to BMCRI were chosen and their fasting plasma homocysteine level were measured. Patients less than 18 years age and had history of cerebral vascular disease, coagulopathy, Alzheimer’s disease were excluded from the study. The data was summarized using mean, standard deviation for parametric data and median, interquartile range for non-parametric data and chi-square test was used for analyzing categorical variables.
Results: Hyperhomocysteinemia was observed in 63.33% of patients with CKD, majority of patients (26.3%) belonged to 50-59 years age group with a significant male (73.7%) preponderance in CKD with hyperhomocysteinemia group. Prevalence of Diabetes and Hypertension in CKD with hyperhomocysteinemia were 73.7% and 82.5% respectively and with a mean duration of Diabetes and Hypertension of 9.82 ± 7.073 years and 7.3 ± 6.545 years respectively. 12.3% patients in CKD with hyperhomocysteinemia were found to have underlying causes for CKD, among them around 57.1% of them had Chronic Interstitial Nephritis. Prevalence of hyperhomocysteinemia was more in end stages of CKD i.e. stage 3B (8.8%), stage 4 (15.8%) & stage 5 (75.4%). Homocysteine elevation was found in both CKD without dialysis and with intermittent hemodialysis.
Conclusion: Serum homocysteine levels appear to be closely associated with CKD and serum homocysteine levels are negatively associated with GFR. Thereby, serum homocysteine levels can be used as a marker of renal dysfunction in patients with diabetes and hypertension.

A study on role of homocysteine as a biochemical marker in various obstetrical complications

Dr. Ankana Singh, Dr. Shweta Goyal, Dr. Rajendra Goyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2134-2140

Low plasma homocysteine (Hyc) level during an uncomplicated pregnancy was first demonstrated by Kang et al. almost 20 yrs ago, & this has subsequently been confirmed by numerous investigators. Plasma homocysteine concentrations are 30-60% lower in pregnant women than in non-pregnant women & the lowest levels are observed in the second trimester.
The study was a hospital based prospective study & carried out in the setting of department of Pathology & department of Obstetrics and Gynae, N.S.C.B Medical College over 100 Females. Homocysteine Tests are conducted at Path Care Labs. The cases with Pre-eclampsia have higher probabilities of having raised Hcy by 1.92% more compared with Non Pre-eclamptic cases and 0.21 at the worst being the Upper and Lower limits of 95% confidence intervals for Odds Ratio (OR=0.66). As per our study the Hcy levels were much raised in patients who were not taking Fe/Folate supplements (50.9%) as compared to those taking Fe/Folate supplement (4.3%) & this difference is highly significant indicating that Folate supplements help in keeping Hcy levels normal.

Correlation of homocysteine with lipid profile in pre & post-menopausal women

Dr. T Sibi Mandela, Dr. Muruga, Dr. Anurag Yadav, Dr. Vinay KS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1791-1795

In Premenopausal women the levels of reproductive hormones are variable and the effects of hormonal withdrawal are present and they may have menstrual cycles which may be regular or irregular. Perimenopause or menstrual transition is the period preceding the menopause characterized by irregular menses and missed cycles which is associated with increase in follicle stimulating hormone levels (> 20 IU/mL). The clinical data pertaining to all patients were recorded as per proforma. A detailed history was taken pertaining to last menstrual period, year of menopause, history of diabetes mellitus, hypertension, cardiac events, and drug intake. The study showed the positive correlation of plasma homocysteine with TC, LDL, VLDL, TG in postmenopausal and premenopausal women and negative correlation of plasma homocysteine with HDL.

Analysis of Co-Relation of Cerebral Venous Sinus Thrombosis with Vitamin B12 and Homocysteine Levels: An Institutional Based Study

Reena Soni, Siddharth Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1371-1376

Introduction: Cerebral venous thrombosis is mostly an uncommon but severe
thrombotic manifestation which has a high mortality rate, has the potential to end in
disability and the greater tendency of recurrence. There are some coagulation
abnormalities such as gain-of-function mutations in the genes that encodes factor V
(factor V Leiden) and prothrombin3 are presented with an increased risk of cerebral
vein thrombosis4-6 whereas there are no data currently reported on the role of
hyperhomocysteinemia as a risk factor for cerebral venous thrombosis. High plasma
levels of total homocysteine (tHcy) result from the connection between genetic and
acquired determinants. Cerebral venous thrombosis is one of the commonest causes of
stroke as far as Indian population is concerned. CVST usually predisposes in the state
of pregnancy and puerperium. The pathological hallmark that is reported in CVST is
haemorrhagic infarction. CVST predominantly occur in the young individuals and can
present with a broad spectrum of clinical manifestations which include headache,
altered sensorium, seizures, focal neurological deficits, papilloedema and cranial nerve
palsies. Headache is the most frequent and often the first reported clinical
manifestation. Homocysteine (Hcy) is a sulfhydryl amino acid compound that is
generated from protein breakdown and the essential amino acid methionine as it is
metabolized to cysteine. Hcy can be broken down in two pathways. When there is in
excess methionine, Hcy is directed to transulphuration pathway where it is irreversibly
conjugated to cysteine. Hcy can also be remethylated in a methionine conserving
pathway and this pathway requires folic acid and MTHFR.



European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 2104-2112

Background: PCOS is the most common endocrinological disorder affecting 6 -14% amongst reproductive age group. The pathophysiology of PCOS is complex and it is still not well understood. Many markers have been studied to correlate between homocysteine level and other clinical, metabolic and hormonal profile. Preliminary investigations indicate that in women with PCOS, serum biomarkers of cardiovascular disorders such as homocysteine are abnormal. Furthermore the interactions between homocysteine and PCOS, biochemical features such as obesity, insulin resistance and higher levels of androgen, have been researched and the potential determinant of this finding is still being explored.
Aim and Objectives: We aim to determine association between hyperhomocysteinemia and PCOS. The objectives of this study is to evaluate and compare clinical, metabolic and 
hormonal profile in women of PCOS with normal homocysteine level with that of increased homocysteine level.
Materials and Methods: This is a prospective observational study which will be performed in the department of obstetrics and gynaecology, AVBRH, DMIMS (Deemed to be University, Wardha), a tertiary care teaching hospital situated in the rural area of Wardha district in over 140 patients for period between 2020-22. This study will include PCOS patients based on Rotterdam diagnostic criteria and will exclude patients with known metabolic, cardiovascular and endocrine disorders. Metabolic and hormonal profile will be evaluated with BMI, Lipid profile, Insulin resistance, serum levels of LH, FSH, DHEA and Testosterone in all patients. Serum homocysteine levels will be measured using ELISA.
Expected Results: We expect that there will be significant difference in clinical, metabolic and hormonal profile of PCOS women having hyperhomocysteinemia than women having normal homocysteine level.


Dr. Sharmeen I. Memon; Dr. Neema S. Acharya

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 2140-2149

Background: One of the major causes of adverse Fetomaternal outcomes have been found to be the various Placenta mediated pregnancy Complications (PMCs). There are inconsistent studies that confirms or proves elevated Serum Homocysteine concentration to be one of the risk factors for Placenta Mediated Complications. Prospective and sufficiently powered studies that uses the pathophysiology of the disease as the basis of their study will help and encourage for a better management of women and fetuses at risk. Hence, this study focuses to determine whether elevated maternal plasma Homocysteine levels in early to mid-second trimester has any significant difference on the occurrence of Placenta-Mediated Complications (PMCs). Objectives: To study and compare the occurrence of Placenta mediated Complications and their Fetomaternal Outcome in women having normal and elevated Serum Homocysteine levels.
Methodology: Females in their early second trimester (Gestational age within 12 -20 weeks) with singleton pregnancy irrespective of taking or not taking periconceptional folic 
acid, presenting for prenatal care in the ANC clinic or planning to deliver at AVBRH Hospital will be selected. Fasting Blood samples will be taken in EDTA Vacutainer tubes and transported to the laboratory within 30min and then the maternal Serum Homocysteine levels will be estimated using the Enzyme-Linked Immunosorbent Assay. Women with raise Plasma Homocysteine Levels will be categorized into Group A and women with Normal Plasma Homocysteine Levels will be categorized into Group B. Pregnancy outcomes and complications will be extracted by studying the antenatal, perinatal, and postnatal medical records and comparison will be made between both the groups for the level of significance.
Results: The Expected Outcome of this study will be a significant difference in the occurrence of Placenta Mediated Complications and related Adverse Fetomaternal Outcomes in women having elevated and normal Serum Homocysteine Levels.
Conclusion: Our Study will prove the role of maternal homocysteine levels in occurrence of Placenta-mediated pregnancy Complications.