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The pathophysiological mechanisms linking hyperho- damage . There are conflicting reports regarding the asso-
16
mocysteinemia and cardiovascular diseases are not fully ciation between homocysteine levels and the frequency of
elucidated, although increased levels of homocysteine in cardiovascular diseases. Numerous studies have shown
the blood are considered a serious risk factor for the early that hyperhomocysteinemia is associated with an increased
development of atherosclerosis . Endothelial dysfunction, risk of myocardial infarction, classifying it as an indepen-
15
as the initial event of atherosclerosis, is also the cause of dent risk factor and a potential marker for identifying precli-
arterial hypertension. With advancing age, compensatory nical stages of the disease 17, 18 . Although some studies have
mechanisms to maintain lower levels of homocysteine in shown that younger patients treated for acute myocardial
the blood are insufficient, leading to elevated homocyste- infarction had elevated homocysteine levels, we were una-
ine in older individuals, further increasing cardiovascular ble to confirm this with our results.
risk . Additionally, several pharmacologically active com-
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pounds increase homocysteine levels, such as antifolates, Serum uric acid (SUA) represents the final product of
methotrexate, nitric oxide oxidizers, L-DOPA, hormone purine metabolism, and its excessive production and redu-
therapy, antiepileptics, and bile acid derivatives. There are ced renal excretion are responsible for the development of
19
also pharmacologically active compounds that lower homo- hyperuricemic conditions in humans . Several studies have
cysteine levels, such as adenosine and related compounds, reported an association between serum uric acid levels and
and sulfhydryl compounds. The toxicity of hyperhomocyste- well-known cardiovascular risk factors, including high blood
inemia can be prevented with B-group vitamins (vitamin B6, pressure 20, 21 , indicating that SUA is an independent risk fa-
vitamin B9 - folic acid, and vitamin B12), which have antioxi- ctor for fatal and non-fatal cardiovascular events in patients
dant and anti-inflammatory effects. with hypertension and patients with diabetes compared to
healthy middle-aged and older individuals .
22
Hyperhomocysteinemia induces the production of
proinflammatory cytokines, including interleukin-1β and High levels of uric acid are associated with higher coro-
interleukin-6, tumor necrosis factor-α (TNFα), monocyte nary artery calcium scores and increased intima-media thic-
chemoattractant protein-1 (MCP-1), and intercellular ad- kness in individuals with high cardiovascular risk. However,
23
hesion molecule-1 (ICAM-1), leading to increased oxidative the association is unclear in apparently healthy individuals .

Conclusion

The research we conducted indicated that individuals with arterial hypertension simultaneously have

multiple cardiovascular risk factors. Non-modifiable risk factors, such as age and male gender, are
more often associated with other risk factors (obesity, smoking, and physical inactivity). Additionally,
the burden of developing cardiovascular diseases increases the association between hypertension,
hyperhomocysteinemia, and dyslipidemia24. All of these factors together accelerate the process
of atherosclerosis, leading to ischemic heart disease and premature death. Prevention plays a
significant role in the early onset of arterial hypertension, as well as in preventing complications.

Literature 4. Yvan-Charvet L, Bonacina F, Guinamard RR, Norata GD.
Immunometabolic function of cholesterol in cardiovascular disease and
beyond. Cardiovasc Res. 2019 Jul 1;115(9):1393-407.
1. GBD 2017 Risk Factor Collaborators. Global, regional, and national
comparative risk assessment of 84 behavioural, environmental and 5. Hanssen H. Lifestyle recommendations as treatment for arterial
occupational, and metabolic risks or clusters of risks for 195 countries hypertension: a time to review. Eur J Prev Cardiol. 2023 Jan 11;30(1):95-
and territories, 1990-2017: a systematic analysis for the Global Burden 7.
of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1923-94. 6. Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G,
2. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Tsalamandris S, et al. Risk factors profile of young and older patients
with myocardial infarction. Cardiovasc Res. 2022 Jul 27;118(10):2281-92.
et al. 2023 ESH Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the 7. Borowczyk K, Piechocka J, Głowacki R, Dhar I, Midtun Ø, Tell GS, et al.
European Society of Hypertension: Endorsed by the International Urinary excretion of homocysteine thiolactone and the risk of acute
Society of Hypertension (ISH) and the European Renal Association myocardial infarction in coronary artery disease patients: the WENBIT
(ERA). J Hypertens. 2023 Dec 1;41(12):1874-2071. trial. J Intern Med. 2019 Feb; 285(2):232-44.
3. Wang X, Feng Y, Yang L, Zhang G, Tian X, Ling Q, et al. Association of 8. Sisti LG, Dajko M, Campanella P, Shkurti E, Ricciardi W, de Waure C. The
baseline serum cholesterol with benefits of intensive blood pressure effect of multifactorial lifestyle interventions on cardiovascular risk
control. Chin Med J (Engl). 2023 Sep 5;136(17):2058-65. factors: a systematic review and meta-analysis of trials conducted in the
general population and high risk groups. Prev Med. 2018 Apr;109:82-97.

ORIGINAL PAPER Galenika Medical Journal, 2024; 3(9):5-10. 9