Linking Diet and Homocysteine to complexity of coronary artery disease using SYNTAX score – A cross sectional study

Background: Hyperhomocystinemia (HHcy) attributed to various causes is considered an independent risk factor in the development and progression of coronary artery disease (CAD). Homocysteine (Hcy) levels are affected by aging, renal dysfunction, hypothyroidism, oral hypoglycemics, dietary deficiency of folic acid (FA), vitamin B6, B12 (B12) and genetic defects. Influence of diet on Hcy and its relation to SYNTAX score was evaluated in newly diagnosed CAD. Methods: A cross-sectional analytical study was conducted in 160 patients aged 40–59 years diagnosed as CAD by the Cardiologist at a tertiary healthcare center. SYNTAX score was calculated using a computer program. Hcy was estimated on the COBAS Pro c503, vitamin B12 (B12) and FA levels were estimated on the COBAS Pro e801 using ROCHE kits. Results: HHcy (>15 μmol/L) was detected in 82 CAD patients and the point estimate of odds ratio was 1.157 with 95 % CI (1.056–1.267) of CAD. CAD patients with HHcy were labelled as Group I; Group II were those with Normal Homocysteine (NHcy) (≤15 μmol/L; n = 78). Hcy had a statistically significant correlation to SYNTAX score (Group I: r = 0.429; Group II: r = 0.233). Majority (n = 65) of Group I were vegetarians showing equal prevalence of high and intermediate risk SYNTAX score. Among them, substantial patients (n = 48) were found to have combined B12 and FA deficiency. Significant number (n = 57) of Group II patients had low risk SYNTAX score irrespective of deficient or sufficient B12/FA status. Conclusion: HHcy was a common finding in nutritionally compromised vegetarian CAD patients contributing to higher risk SYNTAX score.