HIPERHOMOCISTEINEMIJA KAO FAKTOR RIZIKA ZA RAZVOJ PATOLOŠKIH PROMENA U KARDIOVASKULARNOM SISTEMU: MEHANIZMI I POSLEDICE
Sažetak
Hiperhomocisteinemija predstavlja patološko stanje koje karakteriše povećana koncentracija homocisteina u krvi, prelazeći prag od 15 µmol/L. Hiperhomocisteinemija može biti uzrokovana genetskim defektima enzima uključenih u metabolizam homocisteina i neadekvatnog unosa vitamina B6, folne kiseline i/ili vitamina B12, poremećajima funkcije bubrega i štitne žlezde, malignim bolestima, psorijazom i dijabetesom, upotrebom određenih lekova, alkohola, duvana i kofeina. Hiperhomocisteinemija dovodi do oštećenja krvnih sudova putem indukcije proliferacije vaskularnih glatkih mišićnih ćelija, ometanja fizioloških endotelnih funkcija, nakupljanja reaktivnih oblika kiseonika i reaktivnih oblika azota tj. indukcije oksidativnog i nitrozativnog stresa, povećanja produkcije kolagena i degeneracije elastičnih vlakana arterijskog zida, poremećaja produkcije azotnog monoksida, disfunkcije signalnog puta H2S, ćelijske hipometilacije, homocisteinilacije proteina i poremećaja metabolizma lipida. Ovi patofiziološki mehanizmi dovode do ubrzane ateroskleroze koja na kraju rezultira bolestima kao što su akutni infarkt miokarda, srčana insuficijencija, moždani udar i periferna vaskularna bolest. Kod pacijenata sa navedenim bolestima, ili sa pridruženim faktorima rizika kao što su hipertenzija, dijabetes, gojaznost, pušenje ili pozitivna porodična anamneza na koronarnu srčanu bolest od velike je važnosti utvrditi i pratiti koncentraciju homocisteina u krvi i preduzeti mere u vidi promene životnih stilova u cilju sekundarne prevencije posledica koje hiperhomocisteinemija sa sobom nosi.
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