Abstract
Early atherosclerotic-like lesions and thromboemobolic problems are prominent in homocystinuric patients. Recent evidence suggested that mild homocyst(e)inemia, such as is present in heterozygotes for homocystinuria due to cystathionine synthase deficiency, may cause a marked excess in early ischemic heart disease. To evaluate the risk due to mild homocyst(e)inemia, the frequencies of heart attacks and strokes in parents and grandparents of homocystinuric children were assessed in the present study. No statistically significant increases in the incidence of heart attacks or strokes were consistently detected. The data available are sufficient to virtually exclude an increase in the cardiovascular risk for homocystinuria heterozygotes of as much as fivefold compared to controls, and to make very improbable a relative risk of as much as threefold. Less than 5% of homocystinuria heterozygotes are likely to have a fatal or nonfatal heart attack by age 50. These results fail to suggest that mild homecyst(e)inemia is an important contributory factor in the overall incidence of cardiovascular disease.
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- Baumgartner R., Wick H., Ohnacker H., Probst A., Maurer R. Vascular lesions in two patients with congenital homocystinuria due to different defects of remethylation. J Inherit Metab Dis. 1980;3(3):101–103. doi: 10.1007/BF02312541. [DOI] [PubMed] [Google Scholar]
- CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
- DOLL R., HILL A. B. MORTALITY IN RELATION TO SMOKING: TEN YEARS' OBSERVATIONS OF BRITISH DOCTORS. Br Med J. 1964 May 30;1(5395):1399–1410. doi: 10.1136/bmj.1.5395.1399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donahue S., Struman J. A., Gaull G. Arteriosclerosis due to homocyst (e) inemia. Failure to reproduce the model in weanling rabbits. Am J Pathol. 1974 Nov;77(2):167–163. [PMC free article] [PubMed] [Google Scholar]
- GIBSON J. B., CARSON N. A., NEILL D. W. PATHOLOGICAL FINDINGS IN HOMOCYSTINURIA. J Clin Pathol. 1964 Jul;17:427–437. doi: 10.1136/jcp.17.4.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harker L. A., Ross R., Slichter S. J., Scott C. R. Homocystine-induced arteriosclerosis. The role of endothelial cell injury and platelet response in its genesis. J Clin Invest. 1976 Sep;58(3):731–741. doi: 10.1172/JCI108520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kang S. S., Wong P. W., Becker N. Protein-bound homocyst(e)ine in normal subjects and in patients with homocystinuria. Pediatr Res. 1979 Oct;13(10):1141–1143. doi: 10.1203/00006450-197910000-00012. [DOI] [PubMed] [Google Scholar]
- Kanwar Y. S., Manaligod J. R., Wong P. W. Morphologic studies in a patient with homocystinuria due to 5, 10-methylenetetrahydrofolate reductase deficiency. Pediatr Res. 1976 Jun;10(6):598–609. doi: 10.1203/00006450-197606000-00008. [DOI] [PubMed] [Google Scholar]
- McCully K. S. Homocysteinemia and arteriosclerosis. Am Heart J. 1972 Apr;83(4):571–573. doi: 10.1016/0002-8703(72)90051-8. [DOI] [PubMed] [Google Scholar]
- McCully K. S., Ragsdale B. D. Production of arteriosclerosis by homocysteinemia. Am J Pathol. 1970 Oct;61(1):1–11. [PMC free article] [PubMed] [Google Scholar]
- McCully K. S. Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol. 1969 Jul;56(1):111–128. [PMC free article] [PubMed] [Google Scholar]
- McCully K. S., Wilson R. B. Homocysteine theory of arteriosclerosis. Atherosclerosis. 1975 Sep-Oct;22(2):215–227. doi: 10.1016/0021-9150(75)90004-0. [DOI] [PubMed] [Google Scholar]
- Sardharwalla I. B., Fowler B., Robins A. J., Komrower G. M. Detection of heterozygotes for homocystinuria. Study of sulphur-containing amino acids in plasma and urine after L-methionine loading. Arch Dis Child. 1974 Jul;49(7):553–559. doi: 10.1136/adc.49.7.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilcken D. E., Wilcken B. The pathogenesis of coronary artery disease. A possible role for methionine metabolism. J Clin Invest. 1976 Apr;57(4):1079–1082. doi: 10.1172/JCI108350. [DOI] [PMC free article] [PubMed] [Google Scholar]