High homocysteine and low folate concentrations in acute aortic dissection

Background Biomarkers for monitoring progression and prognosis of thoracic aneurysm are of great interest. Homocysteine (Hcy) induces elastolysis in arterial media and may directly affect fibrillin-1 or collagen whereas lipoprotein (Lp) (a) inhibits elastolysis by reducing activation of matrix metallopeptidase-9. Methods We studied 31 consecutive patients with acute aortic dissection (AAD) admitted for emergency surgery (group I, 60±13years old, 25 men), 30 consecutive patients with chronic aneurysms of the ascending aorta (group II, 67±12years old, 24 men) and 20 healthy controls (group III, 58±15years old, 14 men). We evaluated Hcy, folate, B12, Lp(a) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism at baseline. Results Hcy, folate and B12 differed significantly among the 3 studied groups ( P =0.016, P =0.004 and P =0.001, respectively). The levels of Hcy and B12 were significantly higher in group I compared to both groups II and III ( P =0.05 and P =0.002, P P =0.017, respectively) and without significant differences between groups II and III ( P =0.083 and P =0.124). Folate was significantly lower in group I compared to both groups II and III ( P =0.001 and P =0.006, respectively) and without marked difference between groups II and III ( P =0.409). No significant difference was found in serum levels of Lp (a) ( P =0.074) or among the frequency of MTHFR C677T genotypes. Conclusions Patients with AAD present with higher Hcy and lower folate compared to both chronic aneurysms and controls.