How It Affects Your Blood Vessels

What is homocysteine?

Homocysteine is an amino acid (a building block of protein) that is produced in the body.

How is a high homocysteine level harmful?

High homocysteine levels in the blood can damage the lining of the arteries. High levels may also make the blood clot more easily than it should. This can increase the risk of blood vessel blockages. A clot inside your blood vessel is called a thrombus. A thrombus can travel in the bloodstream. From there, it can get stuck in your:

• Lungs (called a pulmonary embolism)
• Brain (which can cause a stroke)
• Heart (which can cause a heart attack)

Some people have very high levels of homocysteine. They are at an increased risk for heart disease.

What causes a high homocysteine level?

Homocysteine is normally changed into other amino acids for use by the body. Vitamin B helps your body use the homocysteine. If your homocysteine level is too high, you may not be getting enough B vitamins.

Most people who have a high homocysteine level don’t get enough folate (also called folic acid), vitamin B6, or vitamin B12 in their diet. Replacing these vitamins often helps return the homocysteine level to normal. Other possible causes of a high homocysteine level include:

• Low levels of thyroid hormone
• Kidney disease
• Psoriasis
• Some medicines
• When the condition is common in your family

How is the homocysteine level measured?

Homocysteine is measured using a simple blood test. Your doctor will order the test only if they suspect you have high levels. If your homocysteine level is too high, you need to lower it. This is especially important if you have blockages in your blood vessels. Sometimes your doctor may take a watchful waiting approach. This means they will monitor your level closely but not take steps to lower it. Your doctor may do this if you have no other major risk factors for cardiovascular disease and you don’t have atherosclerosis (a buildup of plaque in your arteries). If your homocysteine level increases further, you may need to lower it.

No studies have shown that lowering homocysteine levels helps reduce strokes, heart attacks, or other cardiovascular conditions. But a high homocysteine level is a risk for heart disease. So, it’s a good idea to lower it if you can.

Path to improved health

How can I lower a high homocysteine level?

Eating more fruits and vegetables can help lower your homocysteine level. Leafy green vegetables such as spinach are good sources of folate. Other good sources of folate include:

• Many breakfast cereals
• Fortified grain products
• Lentils
• Asparagus
• Most beans

You may need to increase the amount of vitamin B-6 in your diet. Foods that are rich in vitamin B-6 include:

• Fortified breakfast cereals
• Potatoes
• Bananas
• Garbanzo beans (chickpeas)
• Chicken

You also may need to increase the amount of vitamin B-12 you eat. Good sources of vitamin B-12 include:

• Dairy products
• Organ meats (such as liver)
• Beef
• Some types of fish

Adjusting your diet may not be enough to lower your homocysteine level. If it’s not, your doctor may suggest that you take a folate supplement. You may also need to take a vitamin B-6 and vitamin B-12 supplement.

Things to consider

If you start taking folate or vitamin B supplements, you should have your homocysteine level rechecked after 8 weeks. If your homocysteine level remains high, your doctor may have you try a higher dose. You may need to have some tests to see if you have another health condition that causes high homocysteine levels. If you have had a high homocysteine level, you may need to have your level checked more regularly (2 or 3 times a year).

Questions to ask your doctor

• What is causing my homocysteine level to be high?
• Could a high level be the sign of another condition?
• Can I lower my homocysteine level through diet alone?
• Should I take a supplement?
• Can I ask my doctor to check my homocysteine level even if I have no symptoms?

Resources

National Institutes of Health, MedlinePlus: Homocysteine Test

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Homocysteine Test: MedlinePlus Medical Test

What is a homocysteine test?

A homocysteine test measures the amount of homocysteine in a sample of your blood. Homocysteine is an amino acid. Amino acids are molecules that your body uses to make proteins.

Normally, your homocysteine levels are low. That’s because your body uses vitamin B12, vitamin B6, and folic acid (also called folate or vitamin B9) to quickly break down homocysteine and change it into other substances that your body needs. High levels of homocysteine in your blood may be a sign that this process isn’t working properly or that you’re lacking certain B vitamins.

High levels of homocysteine can damage the inside of your arteries and increase your risk of forming blood clots. This may increase your risk for heart attack, stroke, and other heart diseases and blood vessel disorders.

Other names: total homocysteine, plasma total homocysteine

What is it used for?

A homocysteine test may be used to:

• Find out if you’re lacking vitamin B6, B12, or folic acid. These vitamins break down homocysteine. So if you don’t have enough of them, your homocysteine levels will increase. A homocysteine test may be done with a blood test to measure your vitamin B levels.
• Help diagnose homocystinuria. Homocystinuria is a rare, genetic disease that prevents your body from using a certain amino acid to make important proteins. Symptoms usually show up in the first year of life, but they may not appear until childhood or later. Common symptoms include problems with eyesight, blood clots, and weak bones. In the U.S., most newborns have a routine screening test to check for homocystinuria.
• Better understand your risk for heart attack or stroke if you already have an increased risk. Your health care provider may order a homocysteine test if you have been diagnosed with heart or blood vessel disease or if you have conditions that increase your risk for heart and blood vessel disease, such as:
  • High blood pressure
  • High cholesterol
  • Diabetes

Medical experts don’t recommend routine homocysteine testing to screen for heart disease risk in everyone. That’s because researchers aren’t sure how much homocysteine levels affect heart and blood vessel diseases. And so far, studies have shown that lowering homocysteine levels doesn’t reduce the risk of heart attack or stroke.

Why do I need a homocysteine test?

You may need this test if you have symptoms that suggest you lack vitamin B12 or folic acid. The symptoms may be very mild to severe and may include:

• Dizziness
• Fatigue and/or weakness
• Headache
• Heart palpitations (racing or pounding heart)
• Changes in the color of your skin or fingernails
• Sores on your tongue or in your mouth
• Tingling or numbness in your hands, feet, arms, and/or legs

Your provider may order this test if you have a high risk for low levels of vitamin B12 or folic acid because you:

• Have malnutrition.
• Are an older adult. Older people often can’t absorb enough vitamin B12 from food.
• Have alcohol use disorder or a drug addiction.

Your provider may recommend this test if you:

• Have had a heart attack or stroke
• Have one or more conditions that increase your risk for heart attack or stroke, such as high LDL “bad” cholesterol or high blood pressure

What happens during a homocysteine test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You may need to fast (not eat or drink) for 8–12 hours before a homocysteine test. Some medicines and supplements may affect your test results. So, tell your provider about all medicines and supplements you take, especially vitamin B. But never stop taking any medicines unless your provider tells you to.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

A high homocysteine level may be a sign that:

• You are not getting enough vitamin B12 or folic acid in your diet.
• You (or your child) have homocystinuria. You will probably need more testing to rule out or confirm a diagnosis of homocystinuria.
• You may have a higher risk of heart disease, stroke, or other blood vessel disorders.

Higher than normal homocysteine levels may also happen with other conditions, such as osteoporosis, chronic kidney disease, hypothyroidism, or Alzheimer’s disease or other types of dementia.

If your homocysteine levels are high, it doesn’t always mean you have a medical condition that needs treatment. Your results may be affected by:

• Your age. Homocysteine levels may get higher as you get older.
• Your sex. Males usually have higher homocysteine levels than females, but levels in females increase after menopause.
• Smoking

If you have questions about your results, talk with your provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a homocysteine blood test?

If you have high homocysteine levels, your provider may suggest that you make changes in the foods you eat. Eating a balanced diet can help you get the right amount of vitamins. If you’re considering taking vitamin supplements, talk with your provider first. Research has not shown that reducing homocysteine levels can reduce your risk of heart attack or stroke.

References

1. Cleveland Clinic: Health Library: Diagnostics & Testing [Internet]. Cleveland (OH): Cleveland Clinic; c2022.Homocysteine; [reviewed 2021 May 7; cited 2022 June 15]; [about 10 screens]. Available from: https://my.clevelandclinic.org/health/articles/21527-homocysteine
2. Cleveland Clinic: Health Library: Diagnostics & Testing [Internet]. Cleveland (OH): Cleveland Clinic; c2022. Homocysteine Test; [reviewed 2022 Feb 2; cited 2022 June 15]; [about 11 screens]. Available from: https://my.clevelandclinic.org/health/diagnostics/22393-homocysteine-test
3. Mayo Clinic: Mayo Medical Laboratories [Internet]. Mayo Foundation for Medical Education and Research; c1995–2022. Test ID: HCYSS: Homocysteine, Total, Serum: Clinical and Interpretative; [cited 2022 Jun 15]; [about 7 screens]. Available from: https://www.mayocliniclabs.com/test-catalog/overview/35836#Clinical-and-Interpretive
4. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2022. Homocystinuria; [reviewed 2021 Dec; cited 2022 Jun 15]; [about 3 screens]. Available from: https://www.merckmanuals.com/home/children-s-health-issues/hereditary-metabolic-disorders/homocystinuria
5. National Center for Advancing Translational Sciences/Genetic and Rare Diseases Information Center [Internet]. Gaithersburg (MD): U.S. Department of Health and Human Services; Homocystinuria; [updated 2021 Nov 8; cited 2022 Jun 15]; [about 7 screens]. Available from: https://rarediseases.info.nih.gov/diseases/10770/homocystinuria
6. National Institutes of Health: Office of Dietary Supplements [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Vitamin B12: Fact Sheet for Consumers [updated 2021 Jul 7; cited 2022 Jun 15]; [about 10 screens]. Available from: https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/#h6
7. National Institutes of Health: Office of Dietary Supplements [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Folate: Fact Sheet for Consumers [updated 2021 Mar 22; cited 2022 Jun 15]; [about 11 screens]. Available from: https://ods.od.nih.gov/factsheets/Folate-Consumer/#h6
8. Son P, Lewis L. Hyperhomocysteinemia. [Updated 2022 May 8; cited 2022 Jun 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554408/
9. Testing.com [Internet]. Seattle (WA).: OneCare Media; c2022. Homocysteine; [modified 2021 Nov 9; cited 2022 Jun 15]; [about 11 screens]. Available from: https://www.testing.com/tests/homocysteine/
10. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2022. Health Encyclopedia: Homocysteine; [cited 2022 Jun 15]; [about 4 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167& ontented=homocysteine
11. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2022. Homocysteine [updated 2021 Dec 27; cited 2022 Jun 15]; [about 7 screens]. Available from: https://patient.uwhealth.org/healthwise/article/en-us/tu2008

Homocysteine ​​

This non-proteinogenic amino acid is an intermediate in the metabolism of the essential amino acid methionine, which occurs in the presence of folic acid, vitamins B12, B6, B2 and magnesium. Large amounts of methionine are found in meat, milk, cheese, fish, white bread, processed and canned foods.

With a deficiency of the above vitamins, the content of homocysteine ​​in the body increases and hyperhomocysteinemia develops. It causes damage to the inner wall of blood vessels. Violation of the integrity of the endothelium causes the formation of blood clots, atherosclerotic plaques.

People with high levels of homocysteine ​​are at greater risk of developing Alzheimer’s disease and dementia. Against the background of diabetes mellitus, a high level of this amino acid threatens with vascular complications.

During pregnancy, an increased amount of homocysteine ​​can provoke fetoplacental circulation disorders. This can lead to miscarriage, implantation defects of the embryo, intrauterine fetal hypoxia, generalized microangiopathy.

Causes of elevated homocysteine ​​levels

An excess of this amino acid in the blood may be associated with a mutation (most often C677T) in the MTHFR gene. It encodes a protein of the same name, which plays the role of an enzyme in the biosynthesis of homocysteine ​​from methionine.

The cause of hyperhomocysteinemia is also considered to be a lack of folic acid in the body. However, in people with a mutation in the MTHFR gene, its supplementation does not normalize homocysteine ​​levels.

In order to find out the exact cause of the increased concentration of this amino acid, it is necessary to conduct an examination. To determine the genetic prerequisites, you can pass the tests “Folate cycle”, “Impaired hemostasis system”, sequencing of the genes CBS, MTHFR, MTR, MTRR, MMADHC and others at the medical genetic center “Genomed”.

We have prepared for you a list of tests that will help you deal with this problem:

Who needs to get tested for homocysteine?

Indications for testing for the level of this amino acid and the presence of mutations in the MTHFR gene are:

• family history of strokes, heart attacks, thrombosis, ischemic heart disease;
• disorders of the blood coagulation system;
• neurological disorders in children;
• preparation for IVF;
• chromosomal abnormalities in the fetus, congenital pathologies of development, complicated pregnancy;
• smoking.

How is homocysteine ​​tested?

Blood or urine may be used for testing. The material for analysis (blood from a vein) is taken on an empty stomach, 10-12 hours before the test, you can not eat or drink. In the urine, this amino acid should be absent.

A blood homocysteine ​​level of 4–17 µmol/L is considered normal. Low health risks in people with levels less than 12 µmol/l, medium – 12-17 µmol/l, high – above 17 µmol/l.

In children, the normal level is 4.5–5 µmol/l, in adolescents, 6–7 µmol/l. Homocysteine ​​norms for men and women are 5.46-16.2 µmol/l and 4.44-13.56 µmol/l, respectively.

Amino acid concentration in the blood may be increased in diseases. Including diabetes mellitus, renal failure, breast cancer, ovarian cancer, Addison-Birmer anemia, psoriasis, hypothyroidism, lymphoblastic leukemia.

How to normalize homocysteine ​​levels

The doctor takes measures to treat hyperhomocysteinemia, taking into account the results of the examination (including genetic ones). Preparations containing vitamins, folic acid, and anticoagulants may be prescribed. A diet with a reduced amount of foods containing methionine may also be recommended.

Homocysteine, rules for preparing for the test, interpretation of the results and indicators of the norm.

• INVITRO
• Library
• Laboratory…
• Homocysteine ​​

Atherosclerosis

Diabetes mellitus

134

06 November

We remind you that independent interpretation of the results is not allowed, the information below is for reference only.

Homocysteine: indications for the appointment, rules for preparing for the test, interpretation of the results and indicators of the norm.

Indications for study appointment

Homocysteine ​​is an amino acid, an intermediate product of the metabolism (exchange) of other amino acids – methionine and cysteine. Homocysteine ​​does not come from food, but is formed only in the body. Normally, this amino acid “lives” in the body for a very short time, after which it turns into other compounds. For the implementation of such transformations, vitamins B6, B12 and folic acid are needed. In case of violations of the metabolism of homocysteine ​​due to a defect in enzyme systems or due to a lack of essential vitamins, it accumulates in large quantities inside the cells, and then enters the bloodstream.

An excess of homocysteine ​​can lead to the formation of blood clots, damage to the walls of blood vessels, making it looser, to the deposition of cholesterol and calcium in it with the formation of atherosclerotic plaques. The vessels narrowed by atherosclerotic plaques and the tendency to form blood clots significantly increase the likelihood of complete closure of the lumen of the vessels, in particular the vessels of the heart and brain with the development of myocardial infarction and ischemic stroke, respectively. The likelihood of damage to the vascular wall increases significantly with diabetes mellitus.

Thus, one of the indications for prescribing an analysis for homocysteine ​​is to determine the risk of cardiovascular diseases, including in patients with diabetes mellitus.

It is noted that the risk of Alzheimer’s disease and senile dementia (dementia) increases with an increase in the level of homocysteine, therefore, if these diseases are suspected, determining the level of homocysteine ​​\u200b\u200bmay be useful.

With a physiologically proceeding pregnancy, the level of blood homocysteine ​​decreases by almost two times, and in the first trimester by more than 30%, reaching the lowest value at the end of the second trimester. Such a decrease may be associated with an increase in circulating blood volume, hormonal changes. In the case of an increase in the level of homocysteine, pregnancy complications are likely to develop – miscarriages, eclampsia (convulsions with loss of consciousness, a sharp rise in blood pressure and even death), vein thrombosis, etc. In this regard, the determination of the level of homocysteine ​​is prescribed for pregnant women who have an increase in blood pressure, edema, protein in the urine – proteinuria.

An increase in homocysteine ​​occurs in some genetic diseases, such as homocystinuria.

Preparation for procedure

Like any planned study, a blood test for homocysteine ​​should be carried out outside of acute viral and bacterial diseases, two weeks after recovery.

Certain medications may affect test results; it is necessary to discuss with the attending physician the list of drugs used and, possibly, cancel some of them if this does not affect the quality of life.

Blood sampling should be carried out in the morning on an empty stomach, after 8-14 hours of overnight fasting. Drinking water is allowed. It is permissible to take an analysis during the day, 4-6 hours after a light meal.

Homocysteine ​​(Homocysteine)

Homocysteine ​​is an amino acid, an intermediate product formed during the metabolism of the amino acid methionine, a risk factor for the development of atherosclerosis.

…

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Deadline

The analysis is carried out within one business day.

What can affect the results

The result of the analysis for homocysteine ​​may be incorrect if the patient is taking anticancer hormonal drugs, cytostatics, antiepileptic drugs, as well as drugs whose action is aimed at lowering cholesterol, glucose, and some others.

Kidney failure, thyroid dysfunction, alcohol abuse, smoking, drinking large amounts of coffee can also increase the level of homocysteine, which should be taken into account by the doctor when interpreting the results of the analysis.

You can take a blood test for homocysteine ​​at the nearest INVITRO medical office. The list of offices where biomaterial is accepted for laboratory testing is presented in the “Addresses” section.

The interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.

Normal

Age	Floor	Homocysteine ​​level, µmol/l
5 days – 1 year	both	2.87 – 9.99
1 year – 7 years	both	2.76 – 7.62
7 – 12 years old	both	3.43 – 8.45
12 – 15 years old	female	4.07 – 10.36
	male	4. 71 – 10.40
15 – 19years	female	4.92 – 11.88
	male	5.5–13.39
>19 years old	female	4.44 – 13.56
	male	5.46 – 16.20

Explanation of indicators

Values ​​differ depending on the age and gender of the patient. With age, the content of homocysteine ​​increases. Homocysteine ​​levels are higher in men than in women.

What do low readings mean

A decrease in homocysteine ​​can be detected in the initial stages of diabetes mellitus, with increased thyroid function – hyperthyroidism, during pregnancy (in the 1st and 2nd trimesters), as well as in a genetic disease – Down’s syndrome.

Certain medications, such as estrogen preparations, expectorants, and some others, may be associated with low homocysteine ​​levels.

What do elevated readings mean

An increase in homocysteine ​​occurs with a deficiency of folic acid, vitamins B6 and B12, with kidney failure, endocrine disorders – diabetes mellitus and hypothyroidism (decreased thyroid function)

An increase in homocysteine ​​may accompany various severe complications of pregnancy.

Decreased cognitive functions in the elderly (senile dementia, Alzheimer’s disease) may be associated with an increase in homocysteine.

The level of homocysteine ​​tends to increase as a result of taking cytostatics, hypoglycemic drugs, preparations of male sex hormones androgens, etc.

Additional examination in case of deviation from the norm

An analysis for homocysteine ​​is usually prescribed by general practitioners or general practitioners, neurologists, obstetricians-gynecologists and endocrinologists.

When assessing cardiovascular risks, in addition to determining homocysteine, the lipid spectrum, highly sensitive C-reactive protein, glucose, glycated hemoglobin, C-peptide, insulin, etc. are studied.

Lipid profile: extended

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Highly sensitive C-reactive protein (cardio), (high sensitivity CRP, hs-CRP)

Synonyms: Ultrasensitive C-reactive protein; CRP cardio; High-sensitivity C-reactive protein (hs-CRP), quantitative; Cardio CRP; High-sensitivity CRP; Ultra-sensitive CRPs.
Brief description define…

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Glucose (in the blood) (Glucose)

Research material

Serum or blood plasma. If it is not possible to centrifuge the sample 30 minutes after collection for serum/plasma separation…

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Glycated hemoglobin (HbA1С, Glycated Hemoglobin)

Synonyms: Blood test for glycated hemoglobin. Glycohemoglobin; HbA1c; Hemoglobin A1c; A1c; HgbA1c; Hb1c.

Brief characteristics of the analyte Glycated hemo…

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C-Peptide

Synonyms: Blood test for C-peptide; Linking peptide; connecting peptide.
connecting peptide.
Brief description of the analyte С-peptide
C-peptide – side product

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Often together with homocysteine, the level of vitamins B6, B12, folic acid is determined.

Vitamin B12 (cyanocobalamin, cobalamin, Cobalamin)

Vitamin B12 is essential for DNA synthesis, hematopoiesis and the normal functioning of the nervous system.

Synonyms: Cobalamin; cyanocobalamin; Anti…

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Folic Acid

Folic acid is a vitamin necessary for normal DNA synthesis (especially in ontogenesis) and hematopoiesis processes.

Synonyms: Vitamin B9; Folacin; Pte…

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Sources:

1. Kishkun A.A. Clinical laboratory diagnostics: textbook. 2nd edition, revised and enlarged. – M.: GEOTAR-Media. 2019. 1000 s.
2. Zobova D.A., Kozlov S.A. The role of homocysteine ​​in the pathogenesis of certain diseases. News of higher educational institutions. Volga region. Magazine. No. 3(39). 2016. S. 132-144.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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