CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
AFRICA
267
Methods
The study was cross-sectional and prospective. Participants were
recruited by trained field workers and consented voluntarily
in writing. Ethical approval was obtained from the Tshwane
University of Technology Ethics Committee (Ref: 2010/09/004).
A standard informed consent form was signed by all participants.
A questionnaire was used to obtain information on
demographic characteristics, lifestyle, eating habits, health
conditions such as surgical operations, diabetes mellitus,
previous arterial thrombosis, previous pulmonary embolism,
hyperlipidaemia, kidney problems, obesity/overweight and heart
failure. Cardiovascular disease was one of the ailments that no
participants reported to be suffering from.
Fasting blood samples were collected from participants at
the Nobody Clinic in Ga-Mothapo. Subjects who had not fasted
for at least nine hours before sample collection and could not
withdraw medication for that period were excluded from the
study.
Blood was collected by professional nurses. One 4.5-ml blood
sample was collected from each participant in a sodium fluoride
tube for glucose analysis, in a plain tube for triglycerides and
cholesterol estimation, and in an EDTA-anticoagulated tube for
homocysteine level assay.
The body weight of the participants wearing light clothing
without shoes was measured using a weight scale from Omron.
The height was measured without shoes in an upright position
using the Seca telescopic height-measuring rod. The BMI was
calculated using the formula: BMI
=
weight in kg/(height in m)
2
.
Blood pressure was measured using the Omron MI-5. Blood
glucose, triglyceride and cholesterol levels were measured using
the ILab 300 Plus Chemistry System from Beckman Coulter.
Homocysteine was estimated using the Beckman Coulter
Synchron system analyser. Enzymatic methods were used for all
biochemical parameters.
The diagnostic criteria used for the parameters were set
as follows: hyperhomocysteinaemia
=
blood homocysteine
>
15 µmol/l, hyperglycaemia
=
blood glucose
>
7.0 mmol/l,
hypercholesterolaemia
=
blood cholesterol
>
5.7 mmo/l,
hypertriglyceridaemia
=
blood triglyceride
>
2.26 mmol/l,
obesity
=
BMI
>
30 kg/m
2
, systolic blood pressure
>
140 mmHg
=
hypersystolic blood pressure, and diastolic blood pressure
>
90
mmHg
=
hyperdiastolic.
The collected data were analysed with Statistical Package for
Social Science (SPSS) version 18. The results were expressed in
percentages of
p
-values for association. A
p
-value of 0.05 was
regarded as statistically significant.
Results
The study consisted of 382 participants. The mean age of the
study participants was 38.45 years. The mean values for the
studied parameters were as follows: homocysteine 9.44 µmol/l,
glucose 5.42 mmol/l, systolic blood pressure 125.65 mmHg,
diastolic blood pressure 81.06 mmHg, cholesterol 4.18 mmol/l,
triglycerides 1.22 mmol/l and BMI 26.80 kg/m
2
(Table 1).
The associations of hyperhomocysteinaemia with
hyperglycaemia (
p
=
0.175), hypertriglyceridaemia (
p
=
0.442)
and hypercholesterolaemia (
p
=
0.480) were statistically
insignificant. The association of hyperhomocysteinaemia with
obesity was found to be partially significant (
p
=
0.080). The
associations of hyperhomocysteinaemia with hypersystolic (
p
=
0.002) and hyperdiastolic (
p
=
0.033) blood pressures were
statistically significant.
Of the 45 hyperglycaemic participants, three were also
hyperhomocysteinaemic, constituting about 6.7%. Of the
39 hypertriglyceridaemic participants, three were also
hyperhomocysteinaemic, constituting about 7.7%. Of
the 38 hypercholesterolaemic participants, five were also
hyperhomocysteinaemic, constituting about 13.1%. Of the 72
participants with high systolic blood pressure, 11 were also
hyperhomocysteinaemic, constituting about 15.3%. Of the 84
participants with high diastolic blood pressure, 16 were also
hyperhomocysteinaemic, constituting about 19.0%. Of the
95 obese participants, 10 were also hyperhomocysteinaemic,
constituting about 10.5%.
Discussion
We estimated homocysteine levels in 45 hyperglycaemic subjects
for evaluation of association and found no statistical significance
(
p
=
0.175) (Table 2). Three hyperglycaemic subjects (6.7%)
were hyperhomocysteinaemic (Table 3). Different findings about
the relationship have been reported above.
Vayá
et al
., in their study of the relationship between
homocysteine and hyperglycaemia, found a partial association.
15
Elias and Eng, and Shaikh
et al
. reported that homocysteine
levels can be low or elevated in diabetes mellitus.
1,13
These
findings and ours are contrary to the findings of Mishra
et
al
.
2
and Akali
et al
.
12
who found high homocysteine levels in
diabetic patients. They found high levels of homocysteine to be a
strong risk factor in diabetic patients. This was supported by the
findings of Shaikh
et al.
and Schalinske.
1,14
Shaikh
et al
. found more than half of their diabetic
participants had elevated homocysteine levels.
1
The discrepancy
with our results could have been attributable to the influence on
homocysteine of insulin concentrations, therapy with insulin and
TABLE 1. CHARACTERISTICS OF THE PARTICIPANTS
Variable
Mean
±
SD
Age (years)
38.45
±
17.283
Homocysteine (
µ
mol/l)
9.44
±
4.13
Glucose (mmol/l)
5.42
±
2.555
Systolic blood pressure (mmHg)
125.65
±
19.164
Diastolic blood pressure (mmHg)
81.06
±
11.351
Cholesterol (mmol/l)
4.18
±
1.396
Triglycerides (mmol/l)
1.22 (0.83–1.68)
Body mass index (kg/m
2
)
26.80
±
6.20
TABLE 2.
P
-VALUES FOR SIGNIFICANCE OFASSOCIATION
Homocysteinaemia
Metabolic disorder
p
-value
n
=
45
Hyperglycaemia (
n
=
45)
0.175
n
=
39
Hypertriglyceridaemia (
n
=
39)
0.442
n
=
38
Hypercholesterolaemia (
n
=
38)
0.480
n
=
72
Systolic blood pressure (
n
=
72)
0.002
n
=
84
Diastolic blood pressure (
n
=
84)
0.033
n
=
95
Obesity (
n
=
95)
0.080
95% confidence interval and
p
=
0.05 level of significance.
