Homocysteine and post-angioplasty restenosis

Aim: To review the effect of moderate hyperhomocysteinemia on restenosis after coronary angioplasty. Data summary: Hyperhomocysteinemia is associated with arterial neointimal proliferation in subjects with homocystinuria, atherosclerosis and coronary graft disease. In the rat model, it exacerbates neointimal proliferation after carotid injury. In humans, restenosis after coronary angioplasty is inconsistently associated with hyperhomocysteinemia. A large clinical trial has shown that the administration of folic acid lowers homocysteinemia and the risk of restenosis after coronary angioplasty. Conclusion: Hyperhomocysteinemia is probably a weak risk factor for coronary restenosis after angioplasty, although it is still difficult to ascertain whether homocysteine plays a causative role in restenosis. Further studies of restenosis prevention after coronary stenting are necessary before the routine post-angioplasty administration of folic acid can be recommended. (C) 2003, Medikal Press.