Hyperhomocysteinemia and coronary artery disease in Pakistan.

The relative risk of developing coronary artery disease (CAD) in Pakistani men is highest in early ages. Majority of those suffering from CAD belong to the lower middle socioeconomic stratum of the society. Mild hyperhomocysteinemia (concentration of plasma homocysteine between 15-25 micromol/l) is very commonly seen in Pakistani patients with acute myocardial infarction (AMI) as well as in normal healthy subjects. There appears to be a lack of association between hyperhomocysteinemia and CAD in Pakistani population. There is also no evidence of association of methylenetetrahydrofolate reductase 677C>T mutation with CAD in this population. High prevalence of deficiency of folate and vitamin B6 appears to be the major causes of hyperhomocysteinemia in Pakistani population. Deficiencies of micronutrients (folate, vitamin B6 and possibly vitamin B12) along with mild hyperhomocysteinemia, perhaps, act synergistically with other classical risk factors in Pakistani population to further increase the risk of CAD.