PLASMA HOMOCYSTEINE LEVEL AND CORONARY ARTERY DISEASE IN TYPE 2 DIABETIC PATIENTS WITHOUT NEPHROPATHY

Elevated plasma homocysteine (Hcy) is considered to be a novel risk factor for coronary atherosclerosis. Considering the important role of the kidneys in Hcy clearance, the relation, if any, between Hcy and diabetes mellitus (DM) and coronary artery disease (CAD) in diabetic patients is still unclear. The aim of this study was to investigate whether plasma Hcy is a predictor of CAD in patients with type 2 DM without any evidence of nephropathy.

Among type 2 DM patients without nephropathy (cr£1.2 mg/dl) referring for coronary angiography to Tehran Heart Center during 2005, 151 patients were evaluated in this cross sectional study. CAD was confirmed if there was a lumen diameter narrowing > 50 percent in at least one coronary artery. The extent of CAD was determined by the number of affected coronary arteries.

The mean±SD Hcy level was 11.35±3.7 mmol/l. No significant difference was observed between the CAD and control groups (11.52±4.01 mmol/l vs.11.02±3.11 mmol/l, p=0.440).CAD was related to body mass index (p=0.044), systolic blood pressure (p=0.027), HDL-c level (p=0.016), serum creatinine (p=0.042), and HbA1c level (p=0.001). A binary logistic regression analysis found systolic blood pressure (OR: 0.96, p=0.003), creatinine (OR: 24.76, p=0.013), and HbA1c (OR: 2.41, p=0.017) as independent predictors of the presence of CAD.Predictors of the extent of CAD were history of hypertension and current smoking.

In the presence of normal renal function, plasma Hcy level cannot predict either presence or extent of CAD in patients with type 2 DM without nephropathy.