Homocysteine, lipid indices and antioxidants in patients with ischaemic heart disease from Maharashtra, India

Bhagwat VR, Yadav AS, Rathod IM
Correspondence: Dr VR Bhagwat, bhagwatvr@yahoo.co.in

ABSTRACT
Introduction Geographical and ethnic factors have recently been shown to have a significant role to play in cardiovascular diseases. The exact relationship between nutritional and geographical factors in cardiovascular diseases is not very clear. This study examined the relationship of hyperhomocysteinaemia with lipid profile and antioxidants in patients with ischaemic heart disease from rural areas in Maharashtra, India.
Methods Blood cholesterol (total, high- and low-density lipoproteins cholesterol), triglycerides along with thiobarbituric acid reactive substances (TBARS), superoxide dismutase, glutathione peroxidase and catalase activities were measured in acute coronary syndrome (ACS) and chronic stable angina (CSA) patients from rural areas and in normal healthy controls from the same area. Plasma total homocysteine was measured by high pressure liquid chromatography with fluorescence detection. Folic acid and vitamin B12 were measured by chemiluminescence immunoassay.
Results The relative lipid ratios were higher in the patients and had a poor correlation with antioxidants. Total homocysteine levels were significantly higher by almost three times more than the controls. TBARS levels also showed a similar pattern, whereas antioxidant enzymes showed a significantly greater fall in ACS than CSA. There was a definite inverse relationship between total homocysteine, TBARS and antioxidants in the patients. The levels of folic acid and vitamin B12 were 3–4 times higher in the patients compared to the controls. There was a poor correlation between the total homocysteine and vitamin levels in the patients.
Conclusion Blood homocysteine is a very important biomarker of cardiovascular diseases and must be evaluated along with other risk factors. There is a higher prevalence of hyperhomocysteinaemia in rural Indian patients. There appears to be a strong association of genetic factors in the development of ischaemic heart disease in Indian patients.

Keywords: antioxidants, folic acid, homocysteine, ischaemic heart disease, lipids, vitamin B₁₂
Singapore Med J 2009; 50(4): 418-424