Hyperhomocysteinemia is currently regarded as a risk factor for the development
of ischemic heart disease(IHD). We examined the relation between plasma
total homocysteine(tHCY) concentrations and the severity and morphology
of coronary stenosis in 238 Japanese patients. Coronary stenosis score(CS)
in the first quartile of plasma tHCY levels was 4.9 and the second, third
and fourth quartiles were 6.5, 7.5, and 8.9, respectively and plasma tHCY
levels were 8.5, 10.9, 13.5, and 22.4 mmol/l, respectively. CS was higher
in the fourth quartile than in the first, suggesting that plasma tHCY levels
are related to the coronary stenosis severity. Among 238 patients, 123
did not have any significant coronary stenosis(group 1), 98 had focal coronary
stenosis(group 2) and 17 had diffuse coronary stenosis(group 3). Plasma
tHCY level was higher in group 3 than in group 1 or 2, suggesting that
plasma tHCY levels are related to the diffuse coronary stenosis. We also
examined whether hyperhomocysteinemia is concerned in coronary spasm. Plasma
tHCY levels did not differ between 43 patients with vasospastic angina
and 43 patients without ischemic heart disease, suggesting that plasma
tHCY levels are not concerned in coronary spasm. Therefore, in Japanese
patients, plasma tHCY contributes to the development of IHD through the
influence on chronic coronary atherosclerotic background, but not through
the influence on coronary spasm, i.e., one of the acute ischemic stimuli.
Whether or not tHCY influences coronary thrombosis should be clarified
in Japanese patients.
[Rinsho Byori 50 : 807〜814, 2002]
*1Department of Cardiology and Department of Clinical Research, National Kanazawa Hospital, Kanazawa 920-8650
【Key Words】atherosclerosis(動脈硬化)，vasospastic angina(冠攣縮性狭心症)，homocysteine(ホモシステイン)，coronary risk factor(冠危険因子)，ischemic heart disease(虚血性心疾患)
*1,2国立金沢病院循環器科/臨床研究部(〒920-8650 金沢市下石引1-1)
E-mail :nakay@kinbyou.hosp.go.jp