Hyperhomocysteinemia and impaired vasomotor function in type 2 diabetes mellitus

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Abstract
Background Hyperhomocysteinemia has been shown to adversely affect vascular function. The aim of this study was to determine whether hyperhomocysteinemia was independently associated with changes in endothelium‐dependent and ‐independent vasomotor functions in patients with type 2 diabetes mellitus.Materials and methods Fasting homocysteine (tHcy) was measured in 123 patients with type 2 diabetes and in 61 nondiabetic controls. Endothelium‐dependent and ‐independent vasodilation was measured using high‐resolution vascular ultrasound.Results Plasma tHcy concentration was increased in the diabetic patients (11·1 ± 3·7 µmol L−1 vs. 9·8 ± 2·9, P < 0·05). The prevalence of hyperhomocysteinemia (defined as tHcy > 15 µmol L−1) was higher in the diabetic patients (P < 0·05). Within group comparisons showed that both the abnormalities in endothelium‐dependent and ‐independent vasodilation were significantly more severe in diabetic patients with tHcy 10–15 (P < 0·05) and tHcy > 15 µmol L−1 (P < 0·05) than in those patients with tHcy < 10 µmol L−1. When compared with nondiabetic controls matched for tHcy levels, impairment of endothelium‐dependent and ‐independent vasodilation were already evident, even in patients with normal tHcy levels (P < 0·01). Despite significant univariate relationships between tHcy and endothelium‐dependent (r = −0·24, P < 0·01) and ‐independent vasodilation (r = −0·33, P < 0·01) in patients with diabetes, only the relationship between tHcy and endothelium‐independent vasodilation remained significant after adjusting for other cardiovascular risk factors in multiple regression analysis.Conclusions Impairment of endothelium‐dependent and ‐independent vasodilation was already present in diabetic patients with normal tHcy levels, and these abnormalities became more severe with increasing tHcy levels. Only the association between tHcy and endothelium‐independent vasodilation was free of other cardiovascular risk factors.

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