Check your homocysteine levels?

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It is well known that homocysteine plays a role in the pathogenesis of heart disease. Its role, however, for the development of hypertension is not well elucidated.

Homocysteine is a compound which is generated when tissues in the body break down methionine, an essential amino acid. While the formation of homocysteine is understood to be a normal and necessary process, many studies have concluded that a high level of homocysteine in the blood, also known as hyperhomocysteinemia, is associated with an increased risk for coronary artery disease.

How might this happen? Recent evidence suggests that hyperhomocysteinemia contributes in multiple ways to the formation of atherosclerotic plaques. Damaging the inner lining of blood vessels, increasing the blood’s tendency to coagulate, increasing the production of smooth muscle cells in the vessels, and aiding in the formation of the “foam cells” characteristic of atherosclerotic plaques are just a few ways in which hyperhomocysteinemia adds to plaque formation.

It is also beleived that homocysteinemia can contribute to the development of essential hypertension. The mechanism of this disease has not been elucidated, but it may be related to impairment of vascular endothelial cell function and function of smooth muscle cells. Endothelial dysfunction could contribute to alterations of the endothelium-dependent vasomotor regulation, a messenger system that control smooth muscle cell tone. Elevated homocysteinemia diminishes the vasodilation by nitric oxide, increases oxidative stress, stimulates the proliferation of vascular smooth muscle cells, and alters the elastic properties of the vascular wall.

It is believed that homocysteine contributes to elevate the blood pressure. As well, it is believed that elevated plasma levels of homocysteine lead to oxidant injury to the endothelium. Older age, male sex, smoking, genetics, and nutrition each contribute to hyperhomocysteinemia. High homocysteine levels can often be lowered, however, by adding small amounts of folic acid, vitamin B6, and vitamin B12 to the diet. These vitamins are part of the normal pathways which convert homocysteine into other compounds. It is not yet known whether decreasing homocysteine levels this way results in a lower morbidity and mortality. However, many experts believe that supplementing the diet with these vitamins will prove to be a safe and inexpensive way to fight coronary artery disease as well as hypertension.

Article by
Buffalo General Surgeon