Journal
AMERICAN JOURNAL OF CARDIOLOGY
Volume 89, Issue 7, Pages 834-837Publisher
EXCERPTA MEDICA INC
DOI: 10.1016/S0002-9149(02)02194-X
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- NHLBI NIH HHS [HL 52234] Funding Source: Medline
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Atherothrombotic complications are frequently seen in patients undergoing heart transplantation. These patients have high plasma total homocysteine concentrations associated with lower folate and vitamin B-6 levels. The relation between these metabolic abnormalities and the development of vascular complications, however, remains unclear. Fasting plasma total homocysteine, folate, vitamin B-12, vitamin B-6, and creatinine were measured in 160 cardiac transplant recipients who were followed for a mean duration of 28 +/- 9 months after blood draw (mean 59 +/- 28 months after transplant). Cardiovascular events and causes of mortality were determined and Cox proportional-hazards regression analysis was used to identify the independent predictors for cardiovascular events and mortality. Twenty-five patients developed cardiovascular events and 17 died (11 cardiovascular deaths). Mean +/- SD total homocysteine value was 18.4 +/- 8.5 (range 4.3 to 63.5 mumol/L). Hyperhomocysteinemia (greater than or equal to15 mumol/L) was seen in 99 patients (62%). Levels were no different in patients with or without cardiovascular complications/death (16.8 +/- 6.2 vs 18.9 +/- 9 mumol/l., p = 0.4). However, vitamin B-6 deficiency was seen in 21% of recipients with and in 9% without cardiovascular complications/death (p = 0.05). The relative risk for cardiovascular events, including cardiovascular death, increased 2.7 times (confidence interval 1.2 to 5.9) for B-6 levels less than or equal to20 nmol/L compared with those with normal B-6 levels (p = 0.02). Thus, hyperhomocysteinemia is common in transplant recipients but may have no causal role in the atherothrombotic vascular complications of transplantation. Deficiency of vitamin B-6, however, may predict adverse outcomes, suggesting a possible role for supplementation with this vitamin. (C) 2002 by Excerpta Medica, Inc.
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