Impairment of Coronary Circulation by Acute Hyperhomocysteinemia in Type 2 Diabetic Patients
- Antonino Coppola, MD1,
- Costantino Astarita, MD2,
- Michele Oliviero, MD2,
- Dario Fontana, MD2,
- Giuseppe Picardi, MD2,
- Katherine Esposito, MD1,
- Raffaele Marfella, MD, PHD1,
- Ludovico Coppola, MD1 and
- Dario Giugliano, MD, PHD1
- 1Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy
- 2Operative Unit of Cardiology, Ospedale S. Maria della Misericordia, Sorrento, Italy
- Address correspondence and reprint requests to Dr. Antonino Coppola, MD, Second University of Naples, Department of Geriatrics and Metabolic Diseases, Piazza L. Miraglia, 80138 Naples, Italy. Email: dario.giugliano{at}unina2.it
- CFVR, coronary flow velocity reserve
- LAD, left anterior descending
- TTDE, transthoracic Doppler echocardiography
Hyperhomocysteinemia increases the risk of death in type 2 diabetic patients (1,2), although the causal relationship with regard to cardiovascular mortality still remains elusive. Acute elevations in circulating homocysteine levels have been shown to impair endothelial function in coronary microcirculation in normal subjects (3). The objective of the present study was to investigate the effect of acute hyperhomocysteinemia on coronary circulation in patients with type 2 diabetes. Coronary flow velocity reserve (CFVR) assessment by transthoracic Doppler echocardiography (TTDE) is a noninvasive method to evaluate coronary flow reserve and provides important information about coronary endothelial function (4).
RESEARCH DESIGN AND METHODS
Twenty newly diagnosed (within 6 months of diagnosis) type 2 diabetic patients (14 men and 6 women, age 49 ± 8 years, BMI 26.1 ± 1.8 kg/m2) and 20 healthy control subjects, who were matched for age, sex, and BMI, volunteered for this study after informed written consent was obtained. All subjects (both patients and control subjects) were taking no medication or vitamin supplements, and the protocol was approved by the local ethics committee. The diabetic patients were normotensive, had cholesterol levels within normal ranges, and were free from both micro- and macro- …
