Practical Practitioner

By: Pamela Egan, FNP-C CDE

Homocysteine levels an early indicator of heart disease

My Dad who is 76 years old, obese, with type 2 diabetes, renal insufficiency and high blood pressure called me to tell me that all of his lab work was great! Upon further questioning I discovered that his triglycerides were high at nearly 500, his HDL was low at 27, a high creatinine 1.4 (reflects kidney function) and HAIC (average blood sugar for four months) was high at 6.6 percent.

This is typical of metabolic syndrome. Although, he is in his 70s, he is otherwise healthy with a clear mind, so I requested that he ask his provider to order a Cardio-CRP, Homocysteine Level, and 24 hour creatinine clearance. He was hesitant to ask at first, but eventually gave in to his persistent daughter.

Homocysteine is an amino acid normally found in small amounts in the blood. However, high levels of homocysteine in the blood may promote plaque buildup in blood vessels that may, over time, lead to serious cardiovascular problems. Ideally, your homocysteine level should be less than 10.

High levels of homocysteine in the blood may increase your risk of coronary artery disease. Elevated homocysteine levels may also damage the lining of blood vessels, which may lead to the formation of blood clots; these, in turn, may increase your risk of stroke, heart attack, (myocardial infarction), and pulmonary embolism. Also, increased homocysteine levels may promote the formation of blood clots in the deep veins of the legs.

High levels of homocysteine may increase if your diet does not provide an adequate amount of B vitamins, such as folic acid, vitamin B6, and vitamin B12. You can lower high levels of homocysteine in the blood by increasing your dietary intake of these B vitamins.

For example, adequate intake of grain products enriched with folic acid has helped lower homocysteine levels in some people. Prescriptions such as Foltx and METANX include folic acid, B6 and B12 can help to lower homocysteine levels.

C-Reactive Protein is a blood test that measures the amount of C-Reactive Protein (CRP) produced by your liver when you have inflammation somewhere in your body.

Inflammation plays a role in the initiation and progression of atherosclerosis, the chief underlying cause of Myocardial Infarction.

A special type of CRP test, Cardio-CRP, may be done to evaluate your risk for having a sudden heart problem, such as a heart attack. Cardio CRP is a powerful predictor of first and recurrent cardiovascular events. Cholesterol screening fails to identify almost one-half of the 1.3 million individuals who develop heart attacks. Adding Cardio CRP to standard screening significantly improves risk prediction.

Studies have shown that the combination of Cardio CRP with the Total Cholesterol: HDL-Cholesterol ratio is the strongest independent predictor of peripheral artery disease.

Cardio CRP appears to be an excellent marker of persistent plaque instability – Low Risk less than 1.0, Average Risk 1-3, High Risk greater than 3.0.

Remember, prevention is the best medicine.

This article was originally published August 1, 2005 in The St. Tammany News.

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