Hyperhomocystinemia in patients with nonarteritic anterior ischemic optic neuropathy, central retinal artery occlusion, and central retinal vein occlusion1☆,
Section snippets
Patients and methods
All consecutive patients with NAION, CRAO, or CRVO seen at the Retina or Neuro-ophthalmological Unit of the Tel-Aviv Sourasky Medical Center from July 1998 through March 1999 and who agreed to participate in the study were included. Because of the low number of consecutive patients with CRAO seen at our institution during this period (n = 5), we also retrieved the charts of all the patients with CRAO seen in previous years and invited them to participate in the study (n = 8).
A detailed medical
Results
Seventy-four patients (41 males, 33 females) with NAION, CRAO, or CRVO were included in the study group. The control group consisted of 81 healthy adults of similar age and sex (Table 1). The mean age of the NAION and the CRAO groups was not significantly different from the controls (P > 0.5), but the patients in the CRVO group were significantly younger than the controls (P < 0.005).
The mean plasma homocystine level was statistically significantly elevated in the NAION (P = 0.0088) and the
Discussion
The results of our study suggest that the prevalence of hyperhomocystinemia in patients with arterial occlusion (NAION or CRAO) is significantly increased. Moreover, in the NAION group, patients with hyperhomocystinemia had a significantly higher incidence of hypertension and ischemic heart disease. A similar trend was seen for the CRAO group, but the sample was too small to be statistically significant.
In our previous study,44 we investigated the incidence of homozygosity to MTHFR mutation in
References (56)
- et al.
Homocystine and thrombotic disease
Blood
(1997) - et al.
Homocystine decreases bioavailable nitric oxide by a mechanism involving glutathione peroxidase
J Biol Chem
(1997) Metabolism of homocystine thiolactone in human cell cultures. Possible mechanism for pathological consequences of elevated homocystine levels
J Biol Chem
(1997)- et al.
Homocystine and hemostasispathogenic mechanisms predisposing to thrombosis
J Nutr
(1996) - et al.
Hyperhomocystinemia and traditional cardiovascular disease risk factor in end-stage renal disease patients on dialysisa case-control study
Atherosclerosis
(1995) - et al.
Analysis of prothrombotic and vascular risk factors in patients with nonarteritic anterior ischemic optic neuropathy
Ophthalmology
(1999) - et al.
Protein S deficiency and bilateral branch retinal artery occlusion
Ophthalmology
(1991) - et al.
Retinal arterial occlusion in a child with factor V Leiden and thermolabile methylene tetrahydrofolate reductase mutations
Am J Ophthalmol
(1997) - et al.
Hyperhomocystinemia in retinal artery and retinal vein occlusion
Am J Ophthalmol
(1993) - et al.
Elevated erythrocyte aggregation in patients with central retinal vein occlusion and without conventional risk factors
Ophthalmology
(1994)
Retinal vein occlusion and transient monocular visual loss associated with hyperhomocystinemia
Am J Ophthalmol
Bilateral central retinal vein occlusion associated with 5,10-methylenetetrahydrofolate reductase mutation
Am J Ophthalmol
Retinal vein occlusion associated with methylenetetrahydrofolate reductase mutation
Ophthalmology
Determination of plasma homocystine by high-performance liquid chromatography with fluorescence detection
Anal Biochem
Quantitation of total homocystine, total cysteine, and methionine in normal serum and urine using capillary gas chromatography-mass spectrometry
Anal Biochem
Low-dose folic acid supplementation decreases plasma homocystine concentrationsa randomized trial
Am J Clin Nutr
Reduction of homocystine levels in coronary artery disease by low-dose folic acid combined with vitamins B6 and B12
Am J Cardiol
Hyperhomocystinemia as a risk factor for deep-vein thrombosis
N Engl J Med
Homocystine and cardiovascular disease
QJM
A quantitative assessment of plasma homocystine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes
JAMA
Plasma homocystine levels and mortality in patients with coronary artery disease
N Engl J Med
Plasma homocystine as a risk factor for vascular disease. The European Concerted Action Project
JAMA
A Trial of Research in Sulfur Chemistry and Metabolism, and Related Fields
Vascular pathology of homocystinemiaimplications for the pathogenesis of arteriosclerosis
Am J Pathol
Adverse vascular effects of homocystine are modulated by endothelium-derived relaxing factor and related oxides of nitrogen
J Clin Invest
Thermolabile methylenetetrahydrofolate reductasean inherited risk factor for coronary artery disease
Am J Hum Genet
A candidate genetic risk factor for vascular diseasea common mutation in methylenetetrahydrofolate reductase
Nat Genet
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The authors have no proprietary interest in the products mentioned herein.
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Received October 23, 1999. Accepted March 28, 2000.