Homycistine Blood Levels

  Doctor, I may be spelling this heart blood test wrong.  Could you tell me what this test is and what it shows and how accurate the results are.  Thank You Very Much...  I was told it shows vitamin levels?    Ann

[CCF CARDIO MD APS]

Dear Ann,
Homocysteine is an amino acid (building block in the making of proteins in our body-a process which is ever in flux)
and takes quite a few forms in the blood.  It's level is measured in the fasting state and there are many specific criteria for the handling of the blood once drawn; if handled incorrectly
the test can be falsely elevated or simply deranged (not representing the true level.)  The idea of high homocsteine levels being a risk factor for atherosclerosis is itself in flux for there are many concepts to be worked out as well as many controversial issues to be
addressed, for instance once found, what treatment course should be followed.  Currently the accepted normal values in a properly done test are from 5-15 (includes all free,protein bound, and disulfide linked homocysteine particles.)  
Recently I have heard of preliminary data that shows only patients with levels of homocysteine greater than or equal to 20 have an increased risk of death; the numbers of patients in these srudies were small and this often makes the results less reliable.  
To give you more of a straight answer there is a general consensus that elevated homocysteine levels in blood is probably a risk factor for coronary heart disease as well as atherosclerosis in all of the vasculature of the body, however the jury is still out on what levels pose the most risk, the least risk, and who should be treated as well as does the treatment
correspond with a reduction in cardiac events (examples are heart attack and cardiac death.)  
Actually the study of risk factors for coronary artery disease (a disease that runs rampant in this country and a number one cause of death)
is a very hot topic, as is the study of how to predict who will benefit the most from aggressive risk factor modification.  So there are quite a few other 'tests' out there and the information is forthcoming but not yet helpful.  As for the accuracy of the homocysteine level, if done correctly it is a very accurate test.  
Any one who is trying to reduce their risk for heart disease should firstly modify their known risk factors like STOP SMOKING, eat healthy (less than 30% of daily caloric intake from fat), exercise EVERY day, and seek regular medical care for conditions such as diabetes, hypertension, and high cholesterol because all of these conditions increase the likelihood of one's developing heart disease.  
As for the confusion with vitamins you speak of, one of the causes of an elevated homocysteine level can be a deficiency of folate or vitamin B12, as well some prescription drugs have been shown to cause elevated levels; all these factors should be taken in to consideration when the physician is testing a patient's level.  
Information provided in the heart forum is intended for general medical informatinal purposes only, actual diagnosis and treatment can only be made by your physician.