Azhar Ijaz, Sher Zamir, Abdul Sattar, Rahat Jan, Shaukat Ali, Farmanullah Wazir


Background: Coronary artery disease (CAD) is the leading cause of death in the world both in developed and developing countries. Pakistanis are more prone to CAD at younger ages. There are many patients with CAD who lack conventional risk factors. Hyperhomocysteinemia is considered an important modifiable risk factor for CAD. The aim of this study was to establish an association of hyperhomocysteinemia with CAD in younger Pakistani patients with CAD.
Material & Methods: It was a cross sectional comparative study conducted at Punjab Institute of Cardiology Lahore from October 2009 to June 2010. This study included 30 patients of age 20-45 years, with confirmed CAD. They were compared with 30 age matched normal healthy controls. Fasting total homocysteine levels were measured in all the study subjects by Chemiluminescent Microparticle Immunoassay technology. Data was analyzed by SPSS version 16.
Results: Statistically significant difference (p-value = 0.013) was observed in the mean concentration of total homocysteine between the CAD patients (18.1±5.3 µmol/L) and normal controls (14.7±4.93 µmol/L). In the patient group, 21 had homocysteine levels greater than normal value (15 µmol/L) while in the control group, 12 had homocysteine levels greater than normal value. Odds ratio was calculated to be 3.5.
Conclusion: The present study indicates strong association between increased levels of total Homocysteine and CAD in younger Pakistani patients.


Homocysteine; Coronary Artery Disease; Chemiluminescent Microparticle Immunoassay.

Full Text:



Gaziano TA, Bitton A, Anand S, Gessel SA, Murphy A. Growing epidemic of coronary heart disease in low and middle income countries. Curr Prob Cardiol 2010; 35: 72-115.

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007; 297: 286-94.

Habib S. Coronary artery disease in women. Pak Heart J 2011; 44: 18-26.

Khot UN, Kho MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. J Am Med Assoc 2003; 290: 898-904.

Kumakura H, Fujita K, Kanai H, Araki Y, Hojo Y, Kasama S, Iwasaki T, Ichikawa S, Nakashima N, Minami K. High-sensitivity C - reactive protein, Lipoprotein (a) and Homocysteine are Risk Factors for Coronary Artery Disease in Japanese Patients with Peripheral Arterial Disease. J atheroscler Thromb 2015; 22: 344-54.

Angeline T, Aruna RM, Ramadevi K, Mohan G, Jeyaraj N. Homocysteine status and acute myocardial infarction among Tamilians. Ind J Clin Biochem 2005; 20: 18-20.

Verhoef P, Steenge GR, Boelsma E, Vliet TV, Olthof MR, Katan MB. Dietary serine and cystine attenuate the homocysteine-raising effect of dietary methionine: a randomized crossover trial in humans. Am J Clin Nutr 2004; 80: 674-9.

Essawy F, Sayed AE, Madkour B, Hallouda M, Kheir H. Prevalence of hyperhomocysteinemia in peripheral arterial disease: Atherosclerosis and arteritis. Res J Medicine Med Sci 2008; 3: 76-83.

Durand P, Prost M, Lorea, N, Lussier-Cacan S, Blache D. Impaired homocysteine metabolism and atherothrombotic disease. Lab Invest 2001; 81: 645-72.

Tripathi R, Tewari S, Singh PK, Agarwal S. Association of homocysteine and methylene tetrahydrofolate reductase (MTHFR C677T) gene polymorphism with coronary artery disease (CAD) in the population of North India. Genet Mol Biol 2010; 33: 224-8.

Chandalia M, Abate N, Cabo-Chan AV, Devaraj S, Jialal I, Grundy SM. Hyperhomocysteinemia in Asian Indians living in the United States. J Clin Endocrinol Metab 2003; 88: 1089-95.

Guldener CV. Why homocysteine elevated in renal failure and what can be expected from homocysteine-lowering? Nephrol Dial Transplant 2006; 21: 1161-6.

Gorjipour F, Asadi Y, Osguei NK, Effatkhah M, Samadikuchaksaraei A. Serum Level of Homo¬cysteine, Folate and Vitamin-B12 in Epileptic Patients Under Carbamazepine and Sodium Valproate Treatment: A Systematic Review and Meta-Analysis. Iran Red Cres J 2013; 15: 249-53.

Hayta E, Sami Hizmetli S, Atalar MH, Çinar Z . Association of Plasma Homocysteine Level and Carotid Intima-Media Thickness in Rheumatoid Arthritis Patients Receiving Methotrexate. Arch Rheumatol 2015; 30: 214-20.

Salahuddin, Ishaq M, Ahmad SI. Homocysteine level in patients with established transmural myocardial infarction. J Col Pak Surg Phy 2005; 15: 520-3.

Ujjan I D, Sheikh I, Burney A, Shaikh A J, Parveen N, Memon R A, Memon A R, Faroo M, Saqlain M U. Hyperhomocysteinemia and acute myocardial infarction in patients admitted at Isra University Hospital, Hyderabad. Pak J Med Health Sci 2007; 1: 31-2.

Akhtar N, Alam T, Adil M, Waseem H. Homocyste¬ine and coronary artery disease in Pakistan. Pak. J Cardiol 2005; 16: 131-7.

Afzal MN, Humayoun MA, Wasee T, Raza M, Masood A, Akram J. Serum total Homocysteine level: A true cardiovascular risk factor or an acute phase reactant protein? Eur J Cardiovasc Med 2011; 1: 26-30.

Wyk JTV, Wijk MAMV, Sturkenboom MCJM, Moorman, PW, Lei JVDL. Identification of the four conventional cardiovascular disease risk factors by Dutch general practitioners. Chest 2005; 128: 2521-57.

Kullo IJ, Gau, GT, Tajik AJ. Novel risk factors for atherosclerosis. Mayo Clin Proc 2000; 75: 369-80.

Ng KC, Yong QW, Chan SP. Cheng, A. Homocysteine, folate and vitamin B12 as risk factors for acute myocardial infarction in a Southeast Asian population. Ann Acad Med Singapore 2002; 31: 636-40.

Shamsi A, Ahmad M Z, Sultana K, Amir S. Homo¬cysteine and copper level in patients of coronary artery disease. SGH Med Jour 2006; 2: 39-44.

Puri A, Gupta OK, Dwivedi RN, Bharadwag RP, Narain VS,Singh S.. Homocysteine and lipid lev¬els in young patients with coronary artery disease. J Assoc Physicians India 2003; 51: 681-5.

Laghari AH, Memon AN, Shah AM, Ahmad SF, Memon MS. Hyperhomocysteinemia, a risk factor for myocardial infarction in patients with Type-2 Diabetes in Southrern Sindh, Pakistan. Pak J Nutr 2009; 8: 1753-5.

Atif A, Rizvi MA, Tauheed S, Aami, I, Majeed F, Siddiqui K, Khan S. Serum homocysteine concentrations in patients with hypertension. Pak J Physiol 2008; 4: 21-2.

Callaghan PO, Meleady R, Fitzgerald T, Graham I. Smoking and plasma homocysteine. Eur Heart J 2002; 23: 1580-6.

Sammak M E, Kandi M, Hifni S L, Hosni R, Rajab M. Elevated plasma Homocysteine is positively associated with age independent of C677T mu¬tation of the mrthylenetetra hydrofolate reductase gene in selected Egyptian subjects. Int J Med Sci 2004; 1: 181-92.

Gokay S, Cicek D, Muderrisoglu H. Hyperhomocysteinemia in a young woman presenting with acute myocardial infarction: Case report. Inter Med Appl Sci 2013; 4: 39-42.

Garcia G, Trejos J, Restrepo B, Landazuri P. Homocysteine, Folate and Vitamin B12 in Colombian Patients with Coronary Disease. Arq Bras Cardiol 2007; 89: 71-6.

Khurelbaatar MU, Nansalmaa E, Purev A, Dandii Z, Huang SL. Asymptomatic Mongolian middle-aged women with high homocysteine blood level and atherosclerotic disease. Heart Vessels 2010; 25: 7-13.

Yakub M, Iqbal MP, Kakepota GN, Rafique G, Memon Y, Azam I, Mehbooali N, Parveen, Haider, G. High prevalence of mild hyperhomocystein¬emia and folate, B12, and B6 deficiencies in an urban population in Karachi, Pakistan. Pak J Med Sci 2010; 26: 923-9.

Yayehd K, Damorou F, Randrianarisou F, Teherou T, Mottoh N, Nda NW, Pessinaba S. Correlation between Homocysteinemia and Coronary Heart Disease. Res J Cardiol 2012; 10: 1-11.


  • There are currently no refbacks.

Copyright (c) 2020 Azhar Ijaz, Sher Zamir, Abdul Sattar, Rahat Jan, Shaukat Ali, Farmanullah Wazir

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.