Abstract
Objective: To compare the serum homocysteine levels of patients with ischemic heart disease (IHD) with those of normal individuals (those without ischemic heart disease) in our population.
Methods: This is a case-control study, carried out at CMH Rawalpindi during the course of 6 months from June 2024 to Dec 2024. This study included 200 individuals, among whom 130 were patients with ischemic heart disease (angiographically diagnosed coronary artery disease), within the last 3 months, and 70 normal individuals (those without ischemic heart disease), with the closest matching of baseline characteristics with the cases, which comprised the control group. Individuals having other diseases or medications that could raise serum homocysteine levels were excluded from the study. Fasting serum homocysteine levels were measured in both groups and compared.
Results: Mean serum homocysteine levels in patients with ischemic heart disease were higher (23.12 ± 7.16 μmol/L) as compared to normal individuals (9.60 ± 3.17 μmol/L). This difference was statistically significant, with a p-value less than 0.05.
Conclusion: This study demonstrates that patients with ischemic heart disease have higher serum homocysteine levels as compared to normal individuals, suggesting a potential role of homocysteine in the pathogenesis of ischemic heart disease. These findings highlight the importance of serum homocysteine measurement in the risk assessment and management of ischemic heart disease patients.
Keywords: Coronary artery disease, Homocysteine, Risk factor
References
Bartlett ES, Flor LS, Medeiros DS, Colombara DV, Johanns CK, Vaz FAC, Wilson S, Duber HC. Public knowledge of cardiovascular disease and response to acute cardiac events in three municipalities in Brazil. Open Heart. 2020;7(2):e001322. https://doi.org/10.1136/openhrt-2020-001322
Olvera Lopez E, Ballard BD, Jan A. Cardiovascular Disease. [Updated 2023 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
GBD, Results. [https://vizhub.healthdata.org/gbd-results/]
GBoDC N. Global burden of disease study 2019 (GBD 2019) reference life table. Institute for Health Metrics and Evaluation (IHME). 2021.
Samad Z, Hanif B. Cardiovascular diseases in Pakistan: imagining a postpandemic, postconflict future. Circulation. 2023 Apr 25;147(17):1261-3. https://doi.org/10.1161/CIRCULATIONAHA.122.059122
Brown JC, Gerhardt TE, Kwon E. Risk factors for coronary artery disease.
Shenoy V, Mehendale V, Prabhu K, Shetty R, Rao P. Correlation of serum homocysteine levels with the severity of coronary artery disease. Indian Journal of Clinical Biochemistry. 2014 Jul;29:339-44. https://doi.org/10.1007/s12291-013-0373-5
Ahmad A, Corban MT, Toya T, Sara JD, Lerman B, Park JY, Lerman LO, Lerman A. Coronary microvascular endothelial dysfunction in patients with angina and nonobstructive coronary artery disease is associated with elevated serum homocysteine levels. Journal of the American Heart Association. 2020 Oct 6;9(19):e017746. https://doi.org/10.1161/JAHA.120.017746
Kim J, Kim H, Roh H, Kwon Y. Causes of hyperhomocysteinemia and its pathological significance. Archives of pharmacal research. 2018 Apr;41:372-83. https://doi.org/10.1007/s12272-018-1016-4
Zaric BL, Obradovic M, Bajic V, Haidara MA, Jovanovic M, Isenovic ER. Homocysteine and hyperhomocysteinaemia. Current medicinal chemistry. 2019 May 1;26(16):2948-61. https://doi.org/10.2174/0929867325666180313105949
Raghubeer S, Matsha TE. Methylenetetrahydrofolate (MTHFR), the one-carbon cycle, and cardiovascular risks. Nutrients. 2021 Dec 20;13(12):4562. https://doi.org/10.3390/nu13124562
Karadeniz M, Sarak T, Duran M, Alp C, Kandemir H, Celik IE, Simsek V, Kılıc A. Hyperhomocysteinemia predicts the severity of coronary artery disease as determined by the SYNTAX score in patients with acute coronary syndrome. Acta Cardiologica Sinica. 2018 Nov;34(6):458. https://doi.org/10.6515/ACS.201811_34(6).20180528B
Wang B, Mo X, Wu Z, Guan X. Systematic review and meta-analysis of the correlation between plasma homocysteine levels and coronary heart disease. Journal of Thoracic Disease. 2022 Mar;14(3):646. https://doi.org/10.21037/jtd-22-78
Zhou F, He Y, Xie X, Guo N, Chen W, Zhao Y. Homocysteine and multiple health outcomes: an outcome-wide umbrella review of meta-analyses and Mendelian randomization studies. Advances in Nutrition. 2025 Apr 25:100434. https://doi.org/10.1016/j.advnut.2025.100434
Cleveland Clinic. Homocysteine Test: Purpose, Procedure and Results [ Internet]. Cleveland (OH): Cleveland Clinic; 2022
Wang M, Shi J, Song Y, Zhang S, Zhang R. An accurate measurement method for serum homocysteine measurement by ID-LC/MS/MS and the application of external quality assessment. Clinica Chimica Acta. 2025 Jan 15;565:120021. https://doi.org/10.1016/j.cca.2024.120021
Unadkat SV, Padhi BK, Bhongir AV, Gandhi AP, Shamim MA, Dahiya N, et al. Association between homocysteine and coronary artery disease—trend over time and across the regions: a systematic review and meta-analysis. The Egyptian Heart Journal. 2024 Feb 27;76(1):29. https://doi.org/10.1186/s43044-024-00460-y
Li S, Sun L, Qi L, Jia Y, Cui Z, Wang Z, et al. Effect of high homocysteine level on the severity of coronary heart disease and prognosis after stent implantation. Journal of cardiovascular pharmacology. 2020 Jul 1;76(1):101-5. https://doi.org/10.1097/FJC.0000000000000829
Shah H, Jan MU, Altaf A, Salahudin M. Correlation of hyper-homocysteinemia with coronary artery disease in absence of conventional risk factors among young adults. Journal of the Saudi Heart Association. 2018 Oct 1;30(4):305-10. https://doi.org/10.1016/j.jsha.2018.04.002
Rehman T, Shabbir MA, Inam‐Ur‐Raheem M, Manzoor MF, Ahmad N, Liu ZW, et al. Cysteine and homocysteine as biomarker of various diseases. Food science & nutrition. 2020 Sep;8(9):4696-707. https://doi.org/10.1002/fsn3.1818
Azzini E, Ruggeri S, Polito A. Homocysteine: its possible emerging role in at-risk population groups. International journal of molecular sciences. 2020 Feb 20;21(4):1421. https://doi.org/10.3390/ijms21041421
Habib SS, Al-Khlaiwi T, Almushawah A, Alsomali A, Habib SA. Homocysteine as a predictor and prognostic marker of atherosclerotic cardiovascular disease: a systematic review and meta-analysis. European Review for Medical & Pharmacological Sciences. 2023 Sep 15;27(18). https://doi.org/10.26355/eurrev_202309_33784
Kaye AD, Jeha GM, Pham AD, Fuller MC, Lerner ZI, Sibley GT, et al. Folic acid supplementation in patients with elevated homocysteine levels. Advances in Therapy. 2020 Oct;37:4149-64. https://doi.org/10.1007/s12325-020-01474-z.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2025 Laibah Safdar, Tariq Ismail, Fuad Ahmad Siddiqi, Aqsa Amjad, Sidra Saeed, Ammara Amjad

