Relationships between serum hyperhomocysteinemia and carotid atherosclerosis in geriatric patients.

Evaluate the relationships between serum total hyperhomocysteinemia and carotid atherosclerosis. The 102 consecutive patients over the age of 65 epiaortic vessels were examined by means of a high-resolution echo-Doppler and Doppler cw. Depending on the size of the atherosclerotic plaques in the carotid the patients were divided into two groups: a) patients with lesions at high thromboembolic risk (heterogeneous and/or ulcerated plaques, hemodynamically significant stenoses > 70%); b) individuals with low risk carotid involvement (IMT normal and/or thickened by > 0.8 mm and/or lumen stenosed by homogeneous plaques < 70%). The quantitative assay of serum total homocysteinemia (tHCY) was carried out by means of an immunofluorescent method (FPIA). Depending on their tHCY values, the patients were broken down into those with normal tHCY (cut-off 14 mumol/l for the women and 16 mumol/l for the men; 62 patients, M/F = 34/28, mean age 71 +/- 4); patients with mild hyperhomocysteinemia (tHCY 14-18 mumol/l for the women; 16-20 mumol/l for the men; 19 patients, M/F = 11/8; mean age 74 +/- 7); patients with moderate hyperhomocysteinemia tHCY 18 mumol/l for the women; > 20 mumol/l for the men; 21 patients, M/F = 18/3; mean age 74 +/- 7). As against the individuals with normal serum concentrations of HCY (Fig. 2; chi 2: p < 0.05), the patients with mild hyperhomocysteinemia (Odds ratio: OR = 1.48) and, above all, patients with moderate hyperhomocysteinemia (OR = 4.6) were found to have a greater prevalence of carotid lesions at high thromboembolic risk. No significant differences within the three groups were found with regard to distribution by age, gender and the prevalence of the more common cardiovascular risk factors (smoking, diabetes mellitus, arterial hypertension, hyperdyslipidemia). Hyperhomocysteinemia is associated with highly severe carotid lesions at higher risk for cerebrovascular events.