| Homocystine Levels in the Elderly: A Risk Factor Not to be Ignored | ||||||||||||||||||||||||||
| NJ Mehta | ||||||||||||||||||||||||||
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| Homocysteine (Hcy) is a familiar term
now. Since last 15 years or so a number of studies
have been published indicating as one of the newer
independent risk factors for cardiovascular diseases,
complications in pregnancy, congenital malformations,
neuropsychiatric disorders and cognitive functions.
Hyperchromocystenemia has been associated with an
increased risk of both stroke and Alzheimer’s
disease, reinforcing a suspect link between vascular
disease and age related memory loss. Folic acid
in addition to vitamin B6 and B12 plays and important
role in converting homocysteine to the more useful
amino acid methionine. The deficiency of B vitamins
increases blood level of homocysteine and risk of
cardiovascular and other diseases. Elderly men were
studied for social disengagement and incident cognitive
decline (to be published) during a follow up1. From an earlier report,1 out of 182 subjects, 76 more have been added to 50 apparently healthy elderly men2. All biochemical, medical examinations were carried out by their respective clinicians. Biochemical parameters, dietary history showed not much change from earlier study. Out of 126 elders only 10 had borderline elevated levels- 14.6 to 17.8 µmol/l, while 116 had values between 8.8 to 12.0 µmol/l. There are very few Indian studies that give range of homocysteine levels with a large number of apparently healthy elders3, 4, 5 the higher t Hcy levels in the elderly may be due to general slow down of the metabolism, malabsorption, insufficient nutritional supply of folate, vitamin B12 and B6 through diet, reduced renal function and other age related changes, folic acid in combination with B12 +B6 are usually effective to keep the levels of homocysteine controlled. Vegetarian diets consumed in our country contain folic acid, e.g. prolonged heating, boiling followed by discarding water and frying, can destroy folate content by almost 90% or so, this is an Indian paradox. Further, as purely diet will increase the folate consumption, it will reduce the vitamin B12 consumption7, 8. Lipid lowering drugs in the management of hyperhomocysteinemia has been shown to have harmful effects9, 10, there is an increase in homocysteine levels upto 46%. Studies abroad have shown that hyperhomocysteinemia to be an independent risk factor for CHD in Asian Indians even as higher folate concentrations are observed11, and in a Japanese study even as the parameters like total cholesterol, HDL & LDL cholesterol did not show any positive relationship in the CHD patients12. In Indian studies, one showed a positive relation3, the other three did not4,5,6. The prevalence of hyperhomocysteinemia is estimated to be 1:70 in the general population and 40:100 in atherosclerotic patients13.neuroconginitive changes in old age may be mediated by cerebrovascular changes, improve mental capability through its role in protection of the cardiovascular system. The total plasma homocysteine values collected in this report from various labs and with different methodologies are presented in an attempt to stimulate interest and scientific activity in the interest marker particularly for the elderly population. |
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Rajeev Gupta (MD PhD FACC) |
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| Dr.
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