We appreciate the positive remarks by Sener et al.1 regarding our manuscript entitled "Hyperhomocysteinemia Predicts the Severity of Coronary Artery Disease as Determined by the SYNTAX Score in Patients with Acute Coronary Syndrome".2 In our study, we assessed relationship between the severity of coronary artery disease (CAD) and levels of homocysteine in patients with acute coronary syndrome (ACS), and we found that serum homocysteine levels on admission were associated with an increased severity of CAD. We certainly agree that vitamin B12 deficiency is a well known causes of hyperhomocysteinemia and is related with atherosclerosis but vitamin B12 deficiency can be accepted as a risk factor for atherosclerosis depending on homocysteine levels. As reported in previous studies, vitamin B12 deficiency causing hyperhomocysteinemia may be significant for the prediction atherosclerotic process that has been implicated in endothelial dysfunction, cardiovascular disease and the severity and complexity of coronary artery disease via hyperhomocysteinemia.3,4 As we mentioned in the discussion section, we focused mainly on the role of serum homocysteine levels in the prediction of the severity and complexity of CAD, and we discussed several underlying mechanisms to explain our results.
Sener et al. further suggested that lipid lowering agents and metformin are related with increased homocysteine levels and it would be better patients’ medications were evaluated. We agree with Sener and colleagues that there is a need to identify the patients medications which is associated with increased homocysteine levels. Unfortunately, our study did not include a data regarding the use of fibrates or metformin. There might be several limitations in our study, as we mentioned. We will keep in mind that future studies can be designed more clearly.
CONFLICT OF INTEREST
All the authors declare no conflict of interest.
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