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Homocysteine and the Cardiovascular System

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Homocysteine and
The Cardiovascular System

Abstract Cardiovascular disease is considered to be the leading cause of death to date. There are many factors that contribute to cardiovascular disease. Some factors are conventional and straightforward, while others are unconventional and overlooked (Dwivedi, Tripathi, Shukla, Khan, Chauhan, 2011). Homocysteine is an amino acid found in the body that helps to build and maintain tissue. High levels of homocysteine have been linked to endothelial damage to the blood vessels. This damage can lead to plaque formation, thus atherosclerosis can ensue (American Heart Association, 2012). Although there are many causes of hyperhomocysteinemia, research has shown that nutritional replacement has helped to lower the level. Folic acid and B vitamins have shown to decrease homocysteine levels and thus help decrease plaque formation. Patients with high levels of homocysteine are instructed to include folic acid and b vitamins in their diet, restrict methionine, and exercise. Homocysteine is an unconventional risk factor for cardiovascular disease, and can also be used as a risk marker (Milani & Lavi, 2008).

Homocysteine and
The Cardiovascular System
Cardiovascular disease involves all the diseases that affect the heart and vessels. There are many different diseases that affect the cardiovascular system. Atherosclerosis is one of these diseases. Atherosclerosis is characterized by the accumulation of soft, fatty and fibrinous deposits in the arterial vessel walls. These deposits later harden with time. This process can later affect the vascular system resulting in ischemic changes (Huether, McCance, Brashers, & Rote, 2008). The pathophysiology behind atherosclerosis begins with injury to the arterial walls. With this injury come inflammation, fibrin formation, lipid deposits, and plaque formation. The rupture of these plaque deposits result in thrombosis and thus, can lead to myocardial infarction or a stroke. There is said to be many risk factors associated with atherosclerosis. The one risk factor, in particular, being discussed in this paper will be hyperhomocysteinemia. This results in a high concentration of homocysteine in the blood.
Homocysteine is an amino acid made by the body to help build and maintain tissue. Elevated levels can be from genetic defects in homocysteine metabolism or by vitamin deficiencies (Milani & Lavie, 2008). “Acquired hyperhomocysteinemia may results from deficiencies in vitamin B6 or B12, endocrine disease, pernicious anemia, inflammatory bowel disease, renal failure, and therapy with some drugs” (Huether et al., 2008). According to Dwivedi et al. (2011), increased levels of homocysteine are related with acute endothelial dysfunction. High levels of homocysteine in the blood can cause irritation to the lining of the vessels and lead to atherosclerosis.
There is a balance between homocysteine formation and elimination. If the metabolism of homocysteine is impaired, hyperhomocysteinemia can occur. This has been linked to be a risk factor for cardiovascular disease (Dwivedi et al., 2011). Hyperhomocysteinuria results in elevated homocysteine levels in the urine. According to Milani & Lavie (2008):
Elevated levels of homocysteine may promote atherothrombosis by multiple mechanisms. Elevated levels of homocysteine have been shown to accelerate the development of atherosclerotic lesions in animal models, as well as to impair endothelium-dependent vasorelaxation in humans. Hyperhomocysteinemia promotes inflammation by increasing expression of vascular cell adhesion molecule 1(VCAMl) and tumor necrosis factor-a, and increases oxidative modification of low-density lipoproteins, thereby promoting uptake of low-density lipoprotein cholesterol by macrophages. Homocysteine has been shown to activate platelets and promote expression of the CD40/CD40 ligand from activated platelets. The CD40/CD40 ligand engagement on the surface of endothelial cells, smooth muscle cells, or macrophages triggers an additional inflammatory response, characterized by the release of inflammatory cytokines (interleukins IB, 6, 8, 12) and chemokines (chemokine [C-C motif] ligand 2 [CCL2]) as well as expression of adhesion molecules (E selectin, VCAMl, P selectin). Hyperhomocysteinemia also increases concentrations of procoagulant tissue factor and reduces antithrombin III activity. This, in addition to the findings of enhanced activation of metalloproteinases after increases in homocysteine, suggests a predisposition to plaque rupture and thrombosis (p. 1200).
This statement demonstrates how homocysteine affects the cardiovascular system. Basically, to sum up the facts, the end result leads to plaque formation and atherosclerosis.
The best way to help reduce the risk of cardiovascular disease is to reduce the amount of homocysteine in the blood. Studies have shown that folic acid and B vitamins (especially vitamin b6 and b12) help breakdown homocysteine in the body. Homocysteine and vitamin b12 work opposite of each other; an increase in vitamin b12 levels relates to a decrease in homocysteine levels (American Heart Association, 2012). According to Milani & Lavie (2008), vitamin B supplementation, methionine restriction, and exercise training have been found helpful in the reduction of homocysteine levels. However, according to American Heart Association (2012), hyperhomocysteinemia has not yet been truly proven to be a major risk factor for heart disease and people should not overload on folic acid and B vitamins. Instead, the AHA recommends a healthy, balanced diet rich in fruits, vegetables, whole grain, and low fat. According to Milani & Lavie (2008):
Folic acid and vitamin B12 may alter the methylation potential of vascular cells, resulting in a change in the cell phenotype that promotes the development of plaque. Vitamin B6 is involved in numerous enzymatic reactions and biological functions, including cell growth, immunocompetence, and cholesterol metabolism; high levels of B6 may inhibit angiogenesis (p. 1201).
The evidence stated shows the potential side effects of consuming too much folic acid and B vitamins. This should be taken into consideration; however, the AHA does recommend that people who are at a higher risk for atherosclerosis should continue to include a moderate amount of folic acid and B vitamins. These nutritional vitamins can be found in green, leafy vegetables, and fruits (American Heart Association, 2012). In conclusion, homocysteine has been found to be a risk factor for cardiovascular disease. Hyperhomocysteinemia is caused by many reasons including, but not limited to, genetic factors, endothelial damage, kidney disease, and vitamin deficiency. According to the American Heart Association (2012), high levels of homocysteine have been linked to cause damage to the inner lining of blood vessels. The result of the damage caused is atherosclerosis and blood clot formation. Adequate intake of folic acid and B vitamins daily will help reduce hyperhomocysteinemia and help reduce the risk of plaque formation. Homocysteine has been found to be an unconventional risk factor for atherosclerosis and thus, homocysteine levels should be checked to help reduce the risk for atherosclerosis.

References
American Heart Association. (2012, Jan 20). Homocysteine, folic acid and cardiovascular disease. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Homocysteine-Folic- Acid-and-Cardiovascular-Disease_UCM_305997_Article.jsp#.TzcWHvn4LRZ
Dwivedi, M.K., Tripathi, A. K., Shukla, S. & Chauhan, U.K. (2011). Homocysteine and cardiovascular disease. Biotechnology and Molecular Biology Review, 5(5), 101-107
Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2008). Understanding pathophysiology ( 4th ed.) p 245-252. St. Louis, MI: Mosby Elsevier
Milani, R., & Lavie, C. (2008). Homocysteine: the Rubik's cube of cardiovascular risk factors. Mayo Clinic Proceedings, 83(11), 1200-1202

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