Serum high concentrations of homocysteine and low levels of folic acid and vitamin B 12 are significantly correlated with the categories of coronary artery diseases

Ma et al. BMC Cardiovascular Disorders (2017) 17:37 DOI 10.1186/s12872-017-0475-8 RESEARCH ARTICLE Open Access Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases Yan Ma1, Duanliang Peng1, Chenggui Liu2*, Chen Huang2 and Jun Luo1 Abstract Background: Homocysteine (Hcy) has been considered as an independent risk factor for coronary artery disease (CAD). Folic acid and vitamin B12 are two vital regulators in Hcy metabolic process. We evaluated the correlations between serum Hcy, folic acid and vitamin B12 with the categories of CAD. Methods: Serum Hcy, folic acid and vitamin B12 from 292 CAD patients, including 73 acute myocardial infarction (AMI), 116 unstable angina pectoris (UAP), 103 stable angina pectoris (SAP), and 100 controls with chest pain patients were measured, and the data were analyzed by SPSS software. Results: Compared to SAP patients, patients with AMI and UAP had higher Hcy levels with approximately average elevated (4-5) μmol/L, while SAP patients were approximately higher 8 μmol/L than controls. However, the levels of folic acid and vitamin B12 had opposite results, which in AMI group was the lowest, while in controls was the highest. CAD categories were positively correlated with Hcy (r = 0.286, p < 0.001), and negatively correlated with folic acid (r = -0.297, p < 0.001) and vitamin B12 (r = -0.208, p < 0.001). There were significant trend toward increase in the prevalence of high Hcy, low folic acid and vitamin B12 from controls, to SAP, to UAP, and to AMI. Conclusions: The present study provide the valuable evidence that high concentrations of Hcy and low levels of folic acid and vitamin B12 are significantly correlated with CAD categories. Keywords: Homocysteine, Folic acid, Vitamin B12, Coronary artery disease, Atherosclerosis, Endothelial dysfunction Background Coronary artery disease (CAD) is seriously to harm people’s healthy disease in borth developed and developing countries, which was predominantly caused by atherosclerosis with endothelial dysfunction [1, 2]. Despite best efforts, available therapies protect only 30–40% of individuals at risk, and no therapeutic cure is anticipated for those who currently suffer from the disease [3]. The endothelium is a single layer of cells lining all blood vessels. It plays an important role in many physiological functions, including the control of blood cell trafficking, * Correspondence: 2 Department of Clinical Laboratory, Chengdu Women’s and Children’s Central Hospital, Chongqing Medical University, No. 1617 Ri Yue Avenue, Qingyang District, Chengdu 610091, China Full list of author information is available at the end of the article vasomotor tone, vessel permeability, and hemostatic balance. Endothelial cells produce a wide variety of substances in response to various physical and chemical stimuli, including vasodilator substances, and vasoconstrictor substances [4]. Researches have confirmed that endothelial dysfunction, as an impairment of endothelium-dependent relaxation of blood vessels, occur as the initial event in the pathogenesis of atherosclerosis, which considered to be the initiating factor and the key point of cardiovascular disease [5, 6]. Moreover, endothelial dysfunction also play the important role in all stages and categories of CAD from stable angina pectoris (SAP) to unstable angina pectoris (UAP), and to acute myocardial infarction (AMI) [7]. Early warning and immediate risk stratification of patients with different © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ma et al. BMC Cardiovascular Disorders (2017) 17:37 categories of CAD is frequently a challenging task in the current. A large number of studies have confirmed that serum high homocysteine (Hcy) concentration (morm than 15 μmol/L), which is called hyperhomocysteinemia (HHcy), has been associated with endothelial dysfunction of atherosclerotic CAD owing to oxidative stress [8], endoplasmic reticulum stress [9], involved inflammation [10], increased level of asymmetric dimethylarginine (ADMA) [11] and so on [12–14]. Elevated ADMA can results in decreasing endothelium-derived nitric oxide concentration and bioavailability [15]. Nitric oxide as a most important mediator of endothelium-dependent relaxation, is a potent vasodilator, which plays a key role in normal vascular physiology in preserving the vessel wall in a quiescent state by inhibition of inflammation, thrombosis, and cellular proliferation [16]. Decreased nitric oxide bioavailability would result in the abnormal thrombosis, vasorelaxation, and atherosclerosis, thereby promoting the occurrence and development of CAD [17]. Folic acid and vitamin B12 play an important role in regulating the metabolic process of Hcy [18]. Current studies have shown that supplement folic acid, vitamin B12 in patients with HHcy could reduce Hcy levels [19]. Folic acid supplementation not only may be useful in reducing Hcy level in high risk patients with HHcy [20], but also can significantly improve endothelial dysfunction in patients with CAD [21]. On the other hand, folic acid deficiency or/and vitamin B12 deficiency would result in HHcy [22–24]. Vitamin B12 deficiency and HHcy are related to cardiovascular risk factors in patients with CAD [25]. However, the correlations of CAD categories with Hcy, folic acid, vitamin B12 have not been reported. Therefore, we evaluate the correlations between CAD categories and each of the metabolic parameters, anthropometric variables, life style habits and traditional cardiovascular risk factors in CAD patients and controls with chest pain patients. Methods This study included 292 CAD patients (203 male and 89 female) aged 36–85 (62.54 ± 14.52) years, and 100 controls with chest pain symptom (69 male and 31 female) aged 38–87 (60.93 ± 15.65) years, from the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital. There were no statistically significant difference in age (means ± SD, t = 0.94, p = 0.348) and gender (male to female ratio, χ2 = 0.01, p = 0.922) between CAD group and controlled group. All enrolled CAD patients had been confirmed by coronary angiography and were diagnosed to be103 SAP, 116 UAP, 73 AMI according to 2007 ACC/AHA guidelines. 100 controls with chest pain patients in the same period were confirmed by coronary angiography too. Pag (...truncated)