HOMOCYSTEINE AND HEART HEALTH

Homocysteine is an amino acid which is produced in the body as a result of protein breakdown. This amino acid was discovered in 1932 when methionine was treated with sulphuric acid. 

The levels of homocysteine in our body are influenced by various factors like age, gender, genetics, vitamin deficiencies, altered absorption of nutrients in our gastrointestinal tract and lifestyle. The normal level of homocysteine should ideally be between 5-15 micromoles per litre. Elevated levels of homocysteine are referred to as Hyperhomocysteinemia. 

  • Levels between 15-30 micromoles per litre fall under moderate hyperhomocysteinemia.
  • Levels between 31-100 micromoles per litre indicate intermediate hyperhomocysteinemia.
  • Levels more than 100 micromoles per litre is considered as severe hyperhomocysteinemia.

Deficiency of folic acid, vitamin B12 and pyridoxine is associated with high levels of homocysteine. Some of the other reasons can be smoking, hypothyroidism, renal disorders, psoriasis, cancer, diabetes and some medications. Hyperhomocysteinemia is a risk factor of many cardiovascular disorders because it damages the lining of blood vessels, increases the chances of clot formation and atherosclerosis. It has been observed that with increasing age, the mean level of homocysteine rises in the body by 3-5 micromoles per litre and this effect is more seen in men than women. 

Though it does not exhibit any specific symptoms if the underlying cause is micronutrient deficiencies then some people might experience symptoms like -

  1. Fatigue
  2. Mouth sores
  3. Dizziness
  4. Swelling of tongue
  5. Mood swings
  6. Pale skin
  7. Altered heartbeat
  8. Numbness or tingling sensation in arms, hands, feet or legs
  9. Memory loss
  10. Poor muscle health and weight loss

As per a study published in the Journal of the American Heart Association in 2006, hyperhomocysteinemia resulted in a decreased level of high-density lipoprotein (HDL) which resulted in atherosclerosis and coronary artery disease. It inhibits the hepatic synthesis of the main HDL apolipoprotein - apoA-I. HDLs are required by our body due to their antioxidant, anti-thrombotic and anti-inflammatory properties. Therefore, anything which reduces the synthesis or promotes the catabolism of HDL increases our susceptibility to many heart-related disorders. 

Excess of homocysteine in the body also leads to excess production of collagen by smooth muscle cells leading to fibrosis and plaque formation. It increases inflammation in the body, cell death, increased oxidative stress and platelet coagulation. 

Treatment of hyperhomocysteinemia includes promoting the levels of HDL cholesterol by including plenty of fruits, vegetables and whole grains in the diet. Omega 3 intakes are suggested to combat inflammation and improve cholesterol profile. In addition, folate and vitamin B12 rich foods should be included in the diet. If required, supplements can also be opted under medical supervision.

REFERENCES

  • Kamdi, S. P., & Palkar, P. (2013). Prevalence of hyperhomocysteinemia in healthy Indian doctors. Bioinformation9(4), 193–196. https://doi.org/10.6026/97320630009193
  • Ganguly, P., & Alam, S. F. (2015). Role of homocysteine in the development of cardiovascular disease. Nutrition journal14, 6. https://doi.org/10.1186/1475-2891-14-6
  • Barter, Philip J., Rye, Kerry-Anne. (2006). Homocysteine and Cardiovascular Disease.99:565–566.https://doi.org/10.1161/01.RES.0000243583.39694.1f
  • Liao, Dan., et.al. (2006). Hyperhomocysteinemia Decreases Circulating High-Density Lipoprotein by Inhibiting Apolipoprotein A-I Protein Synthesis and Enhancing HDL Cholesterol Clearance. Circulation Research.99:598–606. https://doi.org/10.1161/01.RES.0000242559.42077.22

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