The Relationship between Hyperhomocysteinemia, Haemostatic Factors and Acute Coronary Syndrome in Southeastern Turkey: A Prospective, Comparative Study


Aim: We investigated the relationship between hyperhomocysteinemia, coagulation factors and acute coronary syndrome. Materials and method: The study was conducted at cardiology and hematology department of Dicle University Medical School between January 1st 2003 and May 31st 2009. The study included 96 patients with acute coronary syn-drome and 96 controls. Results: Baseline characteristics of patients (63 males, 33 females, mean age 56.4 years) and controls (58 males and 38 females, mean age: 51.1 years) were similar. There was a statistically significant difference between two groups according to homocysteine levels (13.4 ±8.0 micromole/L vs. 12.8 ± 7.1 micromole/L p = 0.042). In this study, we found that hyperhomocysteinemia, smoking, elevated levels of CRP, low levels of HDL, positive family history, presence of hypertension, BMI > 27, low levels of protein C and protein S were associated with high risk for acute coronary syndrome. Fibrinogen level, factor V level, factor VIII level, factor IX level ,factor X level ,and factor V leiden (p = 0.128) are not risk factors for acute coronary syndrome. Conclusion: Hyperhomocysteine is a significant risk factor for acute coronary syndrome There is not relationship between coagulation factors and acute coronary syn-drome except low levels of protein C and protein S.

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M. Yakut, O. Ayyıldız, S. Batum and S. Alan, "The Relationship between Hyperhomocysteinemia, Haemostatic Factors and Acute Coronary Syndrome in Southeastern Turkey: A Prospective, Comparative Study," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 272-277. doi: 10.4236/ijcm.2011.23044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organizat?on. The world health report 1999: Making a difference. Geneva: WHO, 1999.
[2] Murray CJ, Lopez AD. Global mortality disability, and contribution of risk factors: Global Burden odf disease study. Lancet 1997; 349: 1436-42
[3] Braunwald’s Heart Disease: A Textbook of Cardiovas- cular Medicine, 8th ed.
[4] Mc Cully KS. Vascular pathology of homocysteinemia. Implications for the pathogenesis of arteriosclerosis. Am J Pathol 1969; 56; 11-28
[5] Katic T,Sakic I,Bergovec M. Primary prevention of car- diovascular disease.Acta Med Carotica 2009; 63(1): 71-4
[6] Sacco S,Carolei A. Homocysteine and stroke: another brick in the wall.Clin Sci (Lond). 2009 26; 118(3): 183-5
[7] Wierzbicki AS. Homocysteine and cardiovascular disease: a review of the evidence. Diab Vasc Dis Res. 2007; 4(2): 143-50
[8] Van Oijen MG,Claessen BE,Clappers N, Van Schaik A, Laheij RJ, Lansen JB, Peters WH,Verheugt FW. Prog- nostic value of free plasma homocysteine levels in patients hospitalized with acute coronary syndrome. Am J Cardiol. 2008 15; 102(2): 135-9.
[9] Cheng ML,Ho HY,Lin JF,Chen YC,Chan EC;Chiu DT. Clinical relevance of plasma homocysteine levels in Taiwanese patients with coronary artery disease. Bio- factors. 2008; 34(2):125-34.
[10] Welch GN, Upchurch G Jr , Loscalzo J. Hyperhomo- cysteinemia and atherotrombosis Ann N Y Acad Sci 1997; 811; 48-58
[11] Nehler MR, Taylor LM, Porter JM.Homocysteine as a risc factor for atherosclerosis;A review. Carddiovasc Pathol 1997;6:1-9
[12] Ueland PM, Refsum H, Stabler SP, Malinow MR, Andersson A,. Allen RH. ... clinical applications [Review]. Clin Chem 1993; 39: 1764-79
[13] Kang SS, Wong PW, Malinow MR. Hyperhomo- cyst(e)inemia as a Risk Factor for Occlusive Vascular Disease.Ann Rev Nutr 1992: 12; 279-298
[14] Stubbs PJ, Al-Obaidi MK, Conory RM, Collinson PO. Effects of plasma homocysteine concentration on early and late events in patients with acute coronary send- romes. Circulation 2000; 102: 605-10
[15] NygardO, Nordrehaug JE, Refsum H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997; 337: 230-236.
[16] Torbjorn O, Antia S, Marianne H, et al. Serum homo- cysteine concentration as a indicator of survival in patients with acute coronary sendroms. Arch Intern Med 2000; 160; 1834-40
[17] Boushey CJ, Beresford SAA, Omenn GS , Motoulsky AG. A quantitative assesment of plasma homocysteine as a risc factor for vasculer disease :probable benefits of increasing folic asit intake. JAMA 1995; 274: 1049-1057
[18] Garg UC, Zheng ZJ, Folsom AR, Moyer YS, Tsai MY, McGovern P, Eckfeldt JH. Short-term and long-term variability of plasma homocysteine measurement. Clin Chem. 1997 Jan;43(1):141-145
[19] Taylor LM Jr , De Frang RD ,Harris E J Jr. The association of elevated plasma homocysteine with pro- gression of symptomatic peripheral arterial disease. J Vasc Surg 1991; 13; 128-36
[20] Graham IM, Daly LE ,Refsum HM, et al. Plasma homocysteine as a risk factor for vascular disease: The European Concerted Action Project. JAMA 1997; 277; 1775-81
[21] Alana Majors; L. Allen Ehrhart; Ewa H. Pezacka. Homocysteine as a Risk Factor for Vascular Disease Enhanced Collagen Production and Accumulation by Smooth Muscle Cells. Arteriosclerosis, Thrombosis, and Vascular Biology. 1997; 17: 2074-2081
[22] Boats M, Launer L, Lindermans J,et al.Homocysteine and short –term risk of MI and stroke in the elderly.Rotterdam Study. Arch Intern Med 1999; 159; 38-44
[23] Ray JG. Meta-analysis of hyperhomocysteinemia as arisk factor for venous thromboembolic disease. Arch Intern Med 1998; 158: 2101-16
[24] Ridker PM, Hennekens CH, Selhub J, Miletich JP, Malinow MR, Stampfer MJ. Interrelation of hyperho- mocyst(e)inemia, factor V Leiden, and risks of future venous thromboembolism. Circulation 1997; 95: 1777- 1782
[25] Mart?n TH, Ted K, Henk J Blom, et al. Hiperho- mocysteinemia as a risk factor for deep-vein throm- bosis .N Engl J Med 1996 ; 334 : 759-625
[26] Boers GHJ, Smals AGH, Trijbels FJM, et al. Heterozygosity for homocystinuria in premature peri- pheral and cerebral occlusive arterial disease. N Engl J Med 1985; 313: 709-15.
[27] Selhub J, Jacques PF, Bostom AG, et al. Association between plasma homocysteine concentrations and extrac- ranial carotid-artery stenosis.N Engl J Med 1995; 332: 286-291.
[28] Clarke R, Daly L , Robinson K, et al, Hyperhomo- cysteinemia an independent risk factor for vascular disease . N EngL J Med 1991;324 ;1149-55
[29] Frosst P, Bloom HJ, Milos R, et al. A canditate genetic risk factor for vasculer disease ; a common mutation in MTHFR. Nat Genet 1995; 10: 111-13
[30] Deloughery TG, Evans A, Sadeghi A, et al. Common mutation in MTHFR;correlation with homocysteine meta- bolism and late onset vasculer disease. Circulation 1996; 94; 3074-8
[31] Mudd SH , Skovby F , Levy HL, et al .The natural history of homocystinuria due to cystathionine beta synthase deficiency .Am J Hum Genet 1985; 37: 1-31
[32] Selhub J ,Jacques PF, Wilson PW, Rush D. Vitamine status and intake as primary determinants of homocys- teinemia in an elderly population. JAMA 1993; 270: 2693-8
[33] Kang SS, Wong PW, Norusis M. Homocysteinemia due to folate deficiency. Metabolism. 1987 May; 36(5): 458- 462
[34] Clarke R, Collins R. Can dietary supplements with folic acid or vitamin B6 reduce cardiovascular risk? J Car- diovasc Risk. 1998;5:249-255
[35] Bernard Cantin, Jean-Pierre Despres, Benoit Lamarche, Sital Mooriani, et al. Association of fibrinogen and lipoprotein(a) as a coronary heart disease risk factor in men (The Quebec Cardiovascular Study). Am J Cardiol 2002;89(69):662-666
[36] Krobot K, Hense HW, Cremer P, et al. Determinents of plasma fibrinogen: Relat?on to body weight, waist to hip rat?o, smoking, alcohol, age, sex. Result from the second MON?CA Augsburg survey, 1989/1990. Arterioscler Thromb 1992;12:780-788
[37] Onat A, Hergen? G, Y?ld?r?m B, ve ark. Türk eri?kinlerde kanda fibrinojen düzeyi ve baz? risk parametreleri ile ili?kis.Türk Kardiyoloji Derne?i Ar?ivi 2000;28:115-120
[38] Graves M,Preston F. The hypercoagulable state in clinical practice.Br J Haematol 1991;79:148-151
[39] Anetta Undas, Konstanty Szudrzy,and et al. Systemic blood coagulation activation in acute coronary syndromes. Blood 2009; 113( 9): 2070-2078
[40] Pelkonen KM, Wartiovaara-Kautto U, Nieminen MS, et al. Low normal level of protein C or of antithrombin increases risk for recurrent cardiovascular events. Blood Coagul Fibrinolysis. 2005; 16: 275-280

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