Plasma homocysteine levels are positively correlated with the extent of ischemic myocardial damage in patients presenting with acute coronary syndromes (ACS), a multicenter research team report in
Al-Obaidi and colleagues studied 390 consecutive patients who presented with acute myocardial infarction (MI) or unstable angina pectoris (UA). Analysis of clinical and biochemical parameters revealed that there was a significant increase in peak cardiac troponin T (cTnT) levels in the highest homocysteine quintile (7.85 μg/l,
The team also report that in patients who present with unstable angina, those at greatest risk of cardiovascular events can be identified by cTnT levels >0.2 μ/l, as intracoronary thrombosis leading to peripheral embolization causes cTnT release. This finding is of major clinical significance, as it identifies high-risk patients who would benefit from aggressive thrombolytic therapy (such as glycoprotein IIb/IIIa antagonism). The findings, if confirmed, raise the possibility of using either folic acid and/or vitamin B supplementation to limit myocardial damage during acute ischemic injury, the authors note.