Hyperhomocysteinemia and the Endocrine System: Implications for Atherosclerosis and Thrombosis
Vivian Fonseca,
Susan C. Guba and
Louis M. Fink
Department of Medicine, Section of Endocrinology, Tulane University
Medical School (V.F.), New Orleans, Louisiana 70112; and the Department
of Pathology, University of Arkansas for Medical Sciences and the John
L. McClellan Memorial Veterans Hospital (S.C.G., L.M.F.), Little Rock,
Arkansas
I. Introduction
II. Methionine-Homocysteine Metabolism
A.Methionine metabolism
B. Regulation of remethylation and transsulfurationof H(e)
III. Nomenclature and Methodology in the Measurementof PlasmaH(e)
A. Methionine load test
IV. Determinantsof Plasma Homocysteine
A. Physiological
B. Genetics of hyperhomocysteinemia
C. Nutritional
D. Hormones and H(e) metabolism
V. Homocysteineand Diabetes Mellitus (DM)
A. Hyperhomocysteinemia, renalfailure, and diabetic nephropathy
B. Effect of glucose andinsulin on H(e) metabolism
VI. Hyperhomocysteinemia and CholesterolMetabolism
VII. Hyperhomocysteinemia in Premature VascularDisease
A. Epidemiological and prospective studies
B. Studiesin patients with established vascular disease
C. Negativestudies
D. Effect of low plasma H(e) on cardiovascular disease
VIII. Possible Mechanisms of Accelerated Vascular DiseaseinHomocysteinemia
A. Platelet dysfunction
B. Coagulationabnormalities
C. Effects on the endothelium
D. Effects ofhyperhomocysteinemia on the arterial wall
E. Coinheritanceof factor V Leiden in homocystinuria
IX. Management of Hyperhomocysteinemia
A. Prevention of hyperhomocysteinemia
B. Treatment of hyperhomocysteinemia
X. Conclusion
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