Homocysteine levels are associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

Purpose: Elevated total plasma homocysteine (tHcy) levels and cardiovascular autonomic dysfunction are associated with a high mortality in type 2 diabetic patients. We tested the hypothesis that hyperhomocysteinemia is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. Methods: The study group consisted of 17 type 2 diabetic patients with high tHcy levels (> 15 mmol/ l, age 58 +/- 5 years, high tHcy group). The control group consisted of 23 age-matched type 2 diabetic patients with normal tHcy levels (<= 15 mmol/ l, age 58 +/- 9 years, normal tHcy group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac I-123-metaiodobenzylguanidine ( MIBG) scintigraphy. Results: Early and delayed I-123-MIBG myocardial uptake values were lower ( p< 0.005 and p< 0.01, respectively) and the percent washout rate of I-123-MIBG was higher ( p< 0.001) in the high tHcy group than in the normal tHcy group. The fasting plasma insulin concentrations ( p< 0.0001) and the homeostasis model assessment (HOMA) index values ( p< 0.0001) were higher in the high tHcy group than in the normal tHcy group. Multiple regression analysis revealed that the level of tHcy was independently predicted by the HOMA index values and the myocardial uptake of I-123-MIBG at the delayed phase. Conclusion: Our results demonstrate that high levels of tHcy are associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus.