Interaction of smoking, hyperhomocysteinemia and metabolic syndrome with carotid atherosclerosis: A cross sectional study in 972 non-diabetic patients

Abstract Objective Little is known about the interactions between hyperhomocysteinemia and metabolic syndrome (MetS) in those at risk of atherosclerosis. This study was designed to assess the burden of atherosclerosis in cases with MetS and hyperhomocysteinemia. Research Methods and Procedures We assessed the interaction of MetS with other risk factors including hyperhomocysteinemia in 972 patients with a history of stroke, transient ischemic attack or carotid stenosis. MetS was defined as by the International Diabetes Federation: body mass index ≥30 kg/m² and ≥ 2 of the following: hypertension, high triglycerides, and low high-density lipoprotein. We defined hyperhomocysteinemia as plasma total homocysteine ≥ 14 µmol/L. Patients with diabetes were excluded. Total carotid plaque area (TPA), a strong predictor of cardiovascular risk, was measured by carotid ultrasound. The association of TPA with MetS, and interaction with related risk factors, was assessed by multiple linear regression. Results Complete data were available on 972 non-diabetic patients; 179 (18.4%) had MetS. Subjects with MetS and hyperhomocysteinemia (p Conclusions Patients with MetS and smoking or hyperhomocysteinemia are at particularly high cardiovascular risk. Targeted atherosclerosis prevention should include identification and treatment of metabolic syndrome, smoking and hyperhomocysteinemia (including that due to unrecognized metabolic B12 deficiency).