Abstract
BACKGROUNDAn elevated level of homocysteine (Hcy) has been shown to be a cardiovascular risk factor in the majority of research studies. Recently, it was found to be associated with new risk factors such as inflammatory markers. OBJECTIVESTo investigate the distribution of plasma total Hcy (tHcy) and the levels of inflammatory markers in patients with acute coronary syndrome (ACS), and to evaluate the association between these parameters and the severity of the disease. METHODSA total of 122 patients with ACS and 80 control subjects were recruited from the cardiac intensive care unit of the Military Hospital of Tunis, Tunisia. Lipid profile and the levels of tHcy, high-sensitivity C-reactive protein (HsCRP), interleukin (IL)-6, IL-8, IL-1beta and tumour necrosis factor-alpha (TNFalpha) were determined for all participants. The distribution of these parameters were compared between groups and according to the number of diseased vessels in patients with ACS. RESULTSACS patients had significantly elevated levels of tHcy (P<0.01), HsCRP (P<0.001), IL-6 (P<0.001), TNFalpha (P<0.001), folates (P<0.05) and vitamin B(12) (P<0.001), but lower high-density lipoprotein cholesterol (P<0.05) levels. The analysis of the association between these parameters and the number of diseased vessels showed significant differences in tHcy, HsCRP, IL-6 and TNFalpha, with positive correlations. Significantly negative correlations were found between the number of diseased vessels and folate (r=-0.34; P<0.01), and vitamin B(12) (r=-0.22; P<0.01). CONCLUSIONElevated levels of tHcy, IL-6, TNFalpha and HsCRP appear to be associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease.