Homocysteine and markers of inflammation in acute coronary syndrome.

An elevated homocysteine (Hcy) level is considered to be a risk factor for the development of atherosclerosis. It has been suggested that Hcy influences endothelial function leading to a prothrombotic environment, platelet activation and endothelial leukocyte interactions (1). In addition, Hcy enhances inflammatory responses that are recognized for their role in atherosclerotic disease (2,3). Recent studies (4,5) suggest that markers of inflammation may reflect different aspects of the atherothrombotic process and have a potential role in the prediction of risk for developing coronary artery disease (CAD). In fact, cytokines released from inflammatory cells may reflect the inflammatory process in atherosclerotic plaques. C-reactive protein (CRP) is another proinflammatory factor that has been implicated in the pathogenesis of CAD. Several studies (6) have demonstrated that CRP, measured at either presentation or discharge, may have prognostic value in patients with acute coronary syndrome (ACS). Importantly, biomarkers of different processes may be combined to enhance risk stratification above that of any single marker. The combined effect of Hcy and proinflammatory factors on CAD was recently studied, but not yet clarified. In the present study, we investigated the distribution of plasma total Hcy (tHcy) and the levels of proinflammatory markers in patients with ACS, and evaluated the association between these parameters and disease severity.