Homocysteïnebepaling: Aanvinken of doorhalen?

• An increase in the fasting plasma homocysteine concentration, even within the 'normal range', is a strong and independent predictor of cardiovascular risk • Low concentrations of specific B vitamins and decreased renal function are the most common causes of hyperhomocysteinaemia • Interventional trials with B vitamins showed a decrease in homocysteine levels, but no decrease in cardiovascular disease rates • There are several methodological concerns that preclude the drawing of definite conclusions from the trials; these include the fact that only very mild hyperhomocysteinaemia (>20 μmol/l) was investigated and that possible detrimental effects of high doses of synthetic folic acid were not excluded • Screening for hyperhomocysteinaemia is only indicated in patients with severe premature vascular disease or with indications for an inherited disorder in homocysteine metabolism • Treatment of hyperhomocysteinaemia with moderately high doses of B vitamins should only be considered in severe premature vascular disease or if concentrations are greatly elevated.