Endocrine Abstracts

Introduction: Patients with type 2 diabetes mellitus are considered at least at high cardio-vascular risk. Cardiovascular risk factors must be regularly screened. Hyperhomocysteinemia is considered as an independent risk factor for atherosclerotic disease and coronary disease in some studies. The aim of our study was to confirm the association between hyperhomocysteinemia and atherosclerotic disease in patients with type 2 diabetes.

Methods: We performed a cross-sectional study including 257 type 2 diabetes mellitus patients. For each patient, we looked for personal history of high blood pressure, the duration of diabetes, its treatment and its complications. HbA1c and homocysteine were measured. Hyperhomocysteinemia was diagnosed when homocystein levels were above 15 µmol/l.

Results: The mean age was 59.8±8 years, with extremes ranging from 32 to 84 years old. Mean duration of diabetes was 10.4±5.3 years, with extremes ranging from 3 to 27 years. Hypertension was present and treated in 61.1% of the patients. Mean HbA1c was 8.7±1.9% with extremes ranging from 5.6% to 15.7%. A macrovascular complication was present in 21.8% of cases, with a coronary disease in 17.9%, a cerebrovascular accident in 5.1% and a peripheral artery disease in 1.9% of cases. A microvascular complication was present in 79.4% of cases, with retinopathy in 23.7%, a nephropathy in 31.2%, and a peripheral neuropathy in 54.5% of cases. Mean homocysteine level was 13.3±5.2µmol/l. A hyperhomocysteinemia was found in 26.5% of patients. Hyperhomocysteinemia was positively associated with age (P=0.001), male gender (P=0.001), the presence of a macrovascular complication (P=0.002), and of a cerebrovascular accident (P=0.046). High blood pressure, coronary disease, peripheral artery disease, retinopathy, nephropathy, peripheral neuropathy and HbA1c level were not associated with hyperhomocysteinemia.

Conclusion: Hyperhomocysteinemia is frequent in type 2 diabetic patients. The association between hyperhomocysteinemia and macrovascular complications in particular cerebrovascular disease makes us consider the impact of homocystein levels on the onset of cardiovascular disease and how it consists as a risk factor to monitor.