Hyperhomocysteinaemia and poor vitamin B status in chronic obstructive pulmonary disease

Fimognari, F.L.; Loffredo, L.; Di Simone, S.; Sampietro, F.; Pastorelli, R.; Monaldo, M.; Violi, F.; D'Angelo, A.

doi:10.1016/j.numecd.2008.12.006

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 19, Issue 9 , Pages 654-659, November 2009

Hyperhomocysteinaemia and poor vitamin B status in chronic obstructive pulmonary disease

F.L. Fimognari
- Unit of Respiratory Diseases, Division of Internal Medicine, Leopoldo Parodi Delfino Hospital, ASL Roma G, Colleferro (Rome), Italy
- Correspondence to: Filippo Luca Fimognari, Via Federigo Verdinois 30, 00159 Rome, Italy. Tel.: +39 064066824; fax: +39 0697223215.
L. Loffredo
- Division of IV Medical Clinic, Department of Experimental Medicine and Pathology, University La Sapienza, Rome, Italy
S. Di Simone
- Unit of Respiratory Diseases, Division of Internal Medicine, Leopoldo Parodi Delfino Hospital, ASL Roma G, Colleferro (Rome), Italy
F. Sampietro
- Coagulation Service and Thrombosis Research Unit, S. Raffaele Hospital, IRCCS, Milan, Italy
R. Pastorelli
- Unit of Respiratory Diseases, Division of Internal Medicine, Leopoldo Parodi Delfino Hospital, ASL Roma G, Colleferro (Rome), Italy
M. Monaldo
- Laboratory of Clinical Pathology, Leopoldo Parodi Delfino Hospital, ASL Roma G, Colleferro (Rome), Italy
F. Violi
- Division of IV Medical Clinic, Department of Experimental Medicine and Pathology, University La Sapienza, Rome, Italy
A. D'Angelo
- Coagulation Service and Thrombosis Research Unit, S. Raffaele Hospital, IRCCS, Milan, Italy

Received 12 August 2008; received in revised form 31 October 2008; accepted 5 December 2008. published online 12 March 2009.

Abstract

Background and aims

Patients with chronic obstructive pulmonary disease (COPD) are at increased atherothrombotic risk. Preliminary findings have suggested that COPD patients may have increased plasma total homocysteine (tHcy), a cardiovascular risk factor often caused by a poor B vitamin status, but plasma levels of such vitamins were not measured. The aim of this study was to investigate hyperhomocysteinaemia in COPD and to determine whether it may be secondary to poor plasma concentrations of B vitamins.

Methods and results

We performed a case–control, cross-sectional study of 42 patients with COPD and 29 control subjects. Folate, vitamin B12, vitamin B6, tHcy, renal function, C-reactive protein, blood gases and lipids were measured in patients and controls. COPD patients had higher plasma tHcy (median: 13.9μmol/l, interquantile range [IQR]: 12.1–18.5 versus 11.5, IQR: 10.1–14, p=0.002) and lower circulating folate (median: 2.5ng/ml, IQR: 1.2–3.3 versus 2.8, IQR: 2.1–4 of controls, p=0.03) than controls had. Compared to the control group, COPD was associated with higher tHcy concentrations also after adjusting for smoking, heart failure, renal function and C-reactive protein with logistic regression analysis (OR 1.36, 95% CI 1.06–1.72, p=0.01). In the COPD group, low levels of folate (β=−0.27, p=0.02) and vitamin B12 (β=−0.24, p=0.04), and hypertriglyceridaemia (β=0.580, p<0.0001) were independent predictors of the presence of high tHcy concentrations in a multiple linear regression model (adjusted R²=0.522).

Conclusion

COPD patients have a poor B vitamin status and, as a consequence, increased tHcy. These abnormalities may contribute to the COPD-related atherothrombotic risk.

Keywords: Chronic obstructive pulmonary disease, Hyperhomocysteinaemia, Folic acid, Vitamin B12, Thrombosis

Abbreviations: COPD, chronic obstructive pulmonary disease, FEV1, forced expiratory volume in 1s, FVC, forced vital capacity, tHcy, total homocysteine, HHcy, hyperhomocysteinaemia, CRP, C-reactive protein