HYPERHOMOCYSTEINAEMIA AND CORONARY ARTERY DISEASE IN YOUNG PATIENTS

Original Article

Abstract

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, with premature CAD in patients under 45 years increasingly recognized as a distinct clinical entity where non-traditional risk factors such as hyperhomocysteinemia play a significant role.

Objective: To estimate the prevalence of hyperhomocysteinemia in patients younger than 45 years of age with angiographically documented CAD, and also to identify the relationship between hyperhomocysteinemia and the severity of the disease independent of conventional risk factors.

Study Design: A cross-sectional study.

Place and Duration of Study: Department of Cardiology, Bolan Medical Complex Hospital, Quetta/ Sandeman Provincial Hospital, Quetta, from 01 October 2024 to 31 March 2025

Methodology: This cross-sectional study was conducted in the Cardiology Department of Bolan Medical Complex Hospital, Quetta/ Sandeman Provincial Hospital, Quetta, from 01 October 2024 to 31 March 2025. One hundred patients aged < 45 years with angiographic ally proven CAD were recruited. The level of serum homocysteine was measured by enzymatic immunoassay. The extent of CAD was defined according to the involved vessels. Data on age, gender, lipid profile, smoking, hypertension, and diabetes were collected. Statistical analysis was performed using SPSS v24.0.

Results: Of the 100 patients, 42 (42%) were found to have hyperhomocysteinemia ( ≥ 15 µmol/L). The mean age was 30.4 ± 4.1 years. The high homocysteine patients contained more triple-vessel disease (p = 0.003). No significant difference in smoking, diabetes, or lipid levels was present. The severity of CAD was independently associated with increased homocysteine level. Homocysteine levels were strongly correlated with the number of vessels involved (r = 0.42, p < 0.01).

Conclusion: Hyperhomocysteinemia is an easily determined and potentially modifiable risk factor in younger patients with coronary artery disease. Its close association with disease severity suggests that frequent screening in younger patients with known or potential CAD risk factors could play a significant role in detection and intervention to reduce the impact of early atherosclerosis and improve long-term cardiovascular outcomes in this age group.