Homocysteinaemia in Heart Failure Patients in North Eastern Nigeria

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Y. A. Ayoola
H. I. Okolie
O. M. Akinlade
O. G. Oluwatoyin
M. W. Ali
S. A. Biliaminu


Aims: The study was aimed at determining the relationship between plasma homocysteine level and indices of severity in heart failure patients seen at a referral teaching hospital in Gombe, Northeast Nigeria.

Study Design: It was a hospital based cross-sectional study conducted on newly diagnosed heart failure patients managed by the cardiology unit of the Federal Teaching Hospital, Gombe, between May 2015 and December 2015.

Methodology: Ninety newly diagnosed Heart Failure patients who presented to the hospital along with 90 age and sex matched controls were recruited. All the subjects had clinical and Echocardiography evaluations. Homocysteine was assayed using enzyme-linked Immunosorbent Assay (ELISA) Kit for homocysteine designed by Cloud-clone Corp. Data was analyzed using the Statistical Package for Social Sciences for Windows (SPSS), Version 20.

Results: The mean left ventricular ejection fraction (LVEF) of the patients was 35.4±9.81% while that of the control group was 62.1±7.04% (P <0.001). The mean HCY of patients (11.61 ± 8.00 umol/l) was higher than that of controls (10.24±6.98umol.l), though not significantly; P=0.225. The 90th percentile of the homocysteine (HCY) levels in control was 20.9 umol/l. There was no significant relationship between plasma HCY level and the NYHA class of the patients, though post hoc analysis shows HCY level significantly increased from class I to other classes (P=0.034, P=0.020 and P=0.047 respectively). The bivariate correlation between plasma HCY and Echocardiographic LV indices revealed no statistically significant relationship especially with the LVEF (r-0.149, p=0.160). However, the plasma HCY of the heart failure patients increased with increasing left ventricular mass index (LVMI) (r=0.246, p=0.019).

Conclusion: The study found that homocysteine levels are not significantly elevated in heart failure patients compared with healthy matched controls. However, elevated values were found with increasing left ventricular mass index. This might suggest a possible role of homocysteine in cardiac remodeling.

Heart failure, homocysteine, hyperhomocysteinaemia, Left Ventricular Mass Index (LVMI), North-Eastern Nigeria.

Article Details

How to Cite
Ayoola, Y. A., Okolie, H. I., Akinlade, O. M., Oluwatoyin, O. G., Ali, M. W., & Biliaminu, S. A. (2020). Homocysteinaemia in Heart Failure Patients in North Eastern Nigeria. Journal of Advances in Medical and Pharmaceutical Sciences, 22(4), 39-47. https://doi.org/10.9734/jamps/2020/v22i430168
Original Research Article


Yancy C, Jessup M, Bozkurt B, Butler J, Casey Jr D, Drazner M, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation.

Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB, et al. Lifetime risk for developing congestive heart failure the Framingham heart study. Circulation. 2002;106(24):3068-72.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update. Circulation. 2014;129(3).

Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. Jama. 2009;302(4):394-400.

Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137-46.

Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646-59.

Damasceno A, Cotter G, Dzudie A, Sliwa K, Mayosi BM. Heart failure in sub-Saharan Africa: time for action. J Am Coll Cardiol. 2007;50(17):1688-93.

Kengne AP, Dzudie A, Sobngwi E. Heart failure in sub-Saharan Africa: A literature review with emphasis on individuals with diabetes. Vasc Health Risk Manag. 2008; 4(1):123.

Karaye KM, Sani MU. Factors associated with poor prognosis among patients admitted with heart failure in a Nigerian tertiary medical centre: A cross-sectional study. BMC Cardiovasc Disord. 2008;8 (1):1.

Unachukwu C, Agomuoh D, Alasia D. Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nigeria. Niger J Clin Pract. 2008; 11(1):14-7.

Abengowe C. Cardiovascular disease in Northern Nigeria. Trop Geogr Med. 1979; 31(4):553-60.

Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30-41.

Amoah A, Kallen C. Aetiology of heart failure as seen from a National Cardiac Referral Centre in Africa. Cardiology. 2000; 93(1-2):11-8.

Ladipo G, Froude J, Parry E. Pattern of heart disease in adults of the Nigerian Savanna: A prospective clinical study. Afr J Med Sci. 1977;6(4):185-92.

Kingue S, Dzudie A, Menanga A, Akono M, Ouankou M, Muna W. [A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: Experience of the medicine department at Yaounde General Hospital]. Ann Cardiol Angeiol (Paris). 2005;54(5):276-83.

Refsum M, H, Ueland M, PM, Nygård M, O, Vollset M, Dr. PH, SE. Homocysteine and cardiovascular disease. Annu Rev Med. 1998;49(1):31-62.

Eikelboom JW, Lonn E, Genest J, Hankey G, Yusuf S. Homocyst (e) ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med. 1999;131(5):363-75.

Herrmann W. The importance of hyperhomocysteinemia as a risk factor for diseases: An overview. Clin Chem Lab Med. 2001;39(8):666-74.

Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. Lancet. 1999; 354(9176):407-13.

Vasan RS, Beiser A, D'Agostino RB, Levy D, Selhub J, Jacques PF, et al. Plasma homocysteine and risk for congestive heart failure in adults without prior myocardial infarction. Jama. 2003;289(10):1251-7.

Vizzardi E, Bonadei I, Zanini G, Frattini S, Claudia C, Raddino R, et al. Homocysteine and heart failure: An overview. Recent Pat Cardiovasc Drug Discov. 2009;4(1):15-21.

Herrmann M, Taban‐Shomal O, Hübner U, Böhm M, Herrmann W. A review of homocysteine and heart failure. European Journal of Heart Failure. 2006;8(6):571-6.

McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: The Framingham study. N Engl J Med. 1971;285(26):1441-6.

Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardio. 2011; 57(9):1126-66.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39. e14.

Naruszewicz M, Jankowska EA, Zymlinski R, Bukowska H, Millo B, Banasiak W, et al.

Hyperhomocysteinemia in patients with symptomatic chronic heart failure: Prevalence andprognostic importance pilot study. Atherosclerosis. 2007;194 (2):408-14

Okubadejo NU, Oladipo OO, Adeyomoye AA, Awosanya GO, Danesi MA. Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians. BMC Neurol. 2008;8(1):1

Ebesunun MO, Obajobi EO. Elevated plasma homocysteine in type 2 diabetes mellitus: A risk factor for cardiovascular diseases. Pan Afr Med J. 2012;12(1).

Glew RH, Okolie H, Crossey M, Suberu O, Trujillo M, Pereyra M, et al. Serum lipid

profiles and homocysteine levels in adults with stroke or myocardial infarction in the townof Gombe in northern Nigeria. J Health Popul Nutr. 2004:341-7.

Herrmann M, Kindermann I, Müller S, Georg T, Kindermann M, Böhm M, et al.

Relationship of plasma homocysteine with the severity of chronic heart failure. Clin Chem. 2005;51(8):1512-5

Fokkema MR, Gilissen MF, Van Doormaal JJ, Volmer M, Kema IP, Muskiet FA. Fasting vs nonfasting plasma homocysteine concentrations for diagnosis of hyperhomocysteinemia. Clin Chem. 2003;49(5):818-21.

Glew RH, Williams M, Conn CA, Cadena SM, Crossey M, Okolo SN, et al. Cardiovasculardisease risk factors and diet of Fulani pastoralists of Northern Nigeria. Am J Clin Nutr. 2001; 74(6):730-6.

Frosst P, Blom HJ, Milos R, Goyette P, Sheppard CA, Matthews RG, et al. A candidate genetic risk factor for vascular disease: A common mutation in methylenetetrahydrofolate

reductase. Nat Genet. 1995;10:111-3.

Refsum H, Smith AD, Ueland PM, Nexo E, Clarke R, McPartlin J, et al. Facts and

recommendations about total homocysteine determinations: an expert opinion. Clin Chem. 2004;50(1):3-32

Sundström J, Sullivan L, Selhub J, Benjamin EJ, D'Agostino RB, Jacques PF, et al. Relations of plasma homocysteine to left ventricular structure and function: the

Framingham Heart Study. European Heart Journal. 2004;25(6):523-30.

Wocial B BH, Kostrubiec M, Kuczynska K, Kuch-Wocial A, N N. Homocysteine,

adrenergic activity and left ventricular mass in patients with essential hypertension. Blood Press. 2002;11:201– 5.

Sundström J, Vasan RS. Homocysteine and heart failure: A review of investigations from the Framingham Heart Study. Clin Chem Lab Med. 2005;43(10):987-92.