Homocysteine in lipoprotein apheresis patients--retrospective data analysis in apheresis center of a university hospital.

INTRODUCTION: There is an obvious contrast between the data from the epidemiological studies on hyperhomocysteinemia and the negative results of the homocysteine-lowering clinical trials. Moderate hyperhomocysteinemia might only be relevant in certain subgroups of subjects. The current study was focused on lipoprotein apheresis patients; the study goals were to determine the prevalence of hyperhomocysteinemia, to identify the association between homocysteine levels and cardiovascular events and to test the effects of lipoprotein apheresis and of the conventional homocysteine-lowering therapy.

MATERIALS AND METHODS: Sixty patients from our Lipoprotein Apheresis Center (37 males, 23 females, age 63.1 ± 10.8 years) were included in the study. All patients' records were reviewed with respect to age, sex, BMI, dyslipidemias, arterial hypertension, diabetes mellitus and incidence of vascular events in coronaries, carotids and lower extremities. Homocysteine was measured before and immediately after the apheresis procedure. We also observed the effects of conventional homocysteine-lowering therapy.

RESULTS: The prevalence of hyperhomocysteinemia was 50%. Homocysteine levels correlated positively with number of cardiovascular events (p < 0.03) and serum creatinine (p < 0.0001) and negatively with serum HDL-cholesterol (p < 0.03). Neither oral nor intravenous medication with vitamin B and folic acid showed a significant homocysteine lowering effect. The median relative change value of homocysteine after apheresis session was -12% but was not statistically significant.

CONCLUSIONS: The prevalence of hyperhomocysteinemia in lipoprotein apheresis patients is high. Neither apheresis nor more conventional methods appear to markedly influence homocysteine serum levels.