Serum Homocysteine Level and Ankle-Brachial Index in Peripheral Arterial Disease

Yanna Indrayana, Herpan Syafii Harahap


Patients with peripheral arterial disease have a higher risk of death compared to normal populations. There are several relatively new risk factors significantly increase the vulnerability to suffering from peripheral arterial disease, one of which is homocysteine. Studies investigating the role of serum homocysteine level as a biomarker of the severity of peripheral arterial disease based on an ankle-brachial index (ABI) in the different populations were still limited and it was never been studied in Mataram. This was a cross-sectional study aimed to investigate the correlation between serum homocysteine level and ABI in 77 peripheral artery disease (PAD) outpatients in Siti Hajar Hospital, Mataram. The diagnosis of PAD was based on ABI<0.9. Fasting serum homocysteine level was examined using the ELISA technique. Characteristic data collected were gender, age, hypertension, diabetes mellitus, and body mass index (BMI) category. There was a significant correlation between the increase of serum homocysteine levels and the decrease of ABI. The main risk factors for peripheral arterial disease in the subjects are hypertension, diabetes mellitus, and overweight/obesity. Serum homocysteine level is a predictor of peripheral arterial disease severity measured using ABI.


serum homosisteine level, ankle-brachial index, peripheral arterial disease

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Aggarwal, S., Loomba, R. S., & Arora, R. (2012). Preventive aspects in peripheral artery disease. Therapeutic Advances in Cardiovascular Disease, 6 (2), 53-70.

Alvim, R. O., Dias, F. A., de Oliveira, C. M., Horimoto, A. R., Ulbrich, A. Z., Krieger, J. E., et al. (2018). Prevalence of Peripheral Artery Disease and Associated Risk Factors in a Brazilian Rural Population: The Baependi Heart Study. International Journal of Cardiovascular Sciences, 31 (4), 405-413.

Alzamora, M. T., Forés, R., Baena-díez, J. M., Pera, G., Toran, P., Sorribes, M., et al. (2010). The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health, 10, 38.

Badan Penelitian dan Pengembangan Kesehatan. (2013). RISET KESEHATAN DASAR 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI.

Barroso, M., Handy, D. E., & Castro, R. (2017). The Link Between Hyperhomocysteinemia and Hypomethylation: Implications for Cardiovascular Disease. Journal of Inborn Errors of Metabolism & Screening, 5, 1-15.

Bennett, P. C., Silverman, S., Gill, P. S., & Lip, G. Y. (2009). Ethnicity and peripheral artery disease. Q J Med, 102, 3-16.

Cacciapuoti, F. (2018). Poor re-Methylation of Homocysteine and Trans-Methylation of Methionine: Cause and Effect of Hyper-Homocysteinemia: Which Role for Folic Acid and Vitamins B-6-12 Supplementation? Annals of Clinical & Experimental Motabolism, 3 (1), 1026.

Campia, U., Gerhard-Herman, M., Piazza, G., & Goldhaber, S. Z. (2019). Peripheral Artery Disease : Past, Present, and Future. The American Journal of Medicine, 132, 1133-1141.

Cardiovascular Division and Health Services Research Centre. (2017). Reducing the burden of Cardiovascular Disease in Indonesia. Newton: George Institute for Global Health.

Criqui, M. H., & Aboyans, V. (2015). Epidemiology of Peripheral Artery Disease. Circulation Research, 116, 1509-1526.

Diehm, C., Allenberg, J. R., Pittrow, D., Mahn, M., Tepohl, G., Haberl, R. L., et al. (2009). Mortality and Vascular Morbidity in Older Adults With Asymptomatic Versus Symptomatic Peripheral Artery Disease. Circulation, 120, 2053-2061.

Hankey, G. J. (2018). B vitamins for stroke prevention. Stroke and Vascular Neurology, 3, e000156.

Harahap, H. S., & Indrayana, Y. (2018). Obstructive Sleep Apnea Risk Level Affect Executive Function Rather than Attention. KEMAS, 14 (2), 272-278.

Hicks, C. W., Yang, C., Ndumele, C. E., Folsom, A. R., Heiss, G., Black III, J. H., et al. (2018). Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study. Journal of the American Heart Association, 7, e008644.

Khandanpour, N., Loke, Y. K., Meyer, F. J., Jennings, B., & Armon, M. P. (2009). Homocysteine and Peripheral Arterial Disease : Systematic Review and Meta-analysis. European Journal of Vascular & Endovascular Surgery, 38 (3), 316-322.

Kohlman-Trigoboff, D. (2019). Update: Diagnosis and Management of Peripheral Arterial Disease. The Journal for Nurse Practitioners, 15 (1), 87-95.

Krishnan, M. N., Geevar, Z., Mohanan, P. P., Venugopal, K., & Devika, S. (2018). Prevalence of peripheral artery disease and risk factors in the elderly: A community based cross-sectional study from northern Kerala, India. Indian Heart Journal, 70 (6), 808-815.

Lai, W. K., & Kan, M. Y. (2015). Homocysteine-Induced Endothelial Dysfunction. Annals of Nutrition and Metabolism, 67, 1-12.

Maharani, A., Sujarwoto, Praveen, D., Delvac, O., Tampubolon, G., & Patel, A. (2019). Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study. PloS ONE, 14 (4), e0215219.

Mihardja, L., Soetrisno, U., & Soegondo, S. (2014). Prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians. Journal of Diabetes Investigation, 5, 507-512.

Murata, N., Soga, Y., Iida, O., Yamauchi, Y., Hirano, K., Kawasaki, D., et al. (2015). Complex Relationship of Body Mass Index with Mortality in Patients with Critical Limb Ischemia Undergoing Endovascular Treatment. European Journal of Vascular & Endovascular Surgery, 49 (3), 297-305.

Mury, P., Chirico, E. N., Mura, M., Millon, A., Canet-Soulas, E., & Pialoux, V. (2018). Oxidative Stress and Infammation, Key Targets of Atherosclerotic Plaque Progression and Vulnerability: Potential Impact of Physical Activity. Sports Medicine, 48 (12), 2725-2741.

Olin, J., & Sealove, B. (2010). Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management. Mayo Clinic Proceedings, 85 (7), 678-692.

Omae, T., Nagaoka, T., Tanano, I., & Yoshida, A. (2013). Homocysteine Inhibition of Endothelium-Dependent Nitric Oxide-Mediated Dilation of Porcine Retinal Arterioles via Enhanced Superoxide Production. Investigative Ophthalmology & Visual Science, 54 (3), 2288-2295.

Peltzer, K., & Pengpid, S. (2018). The Prevalence and Social Determinants of Hypertension among Adults in Indonesia: A Cross-Sectional Population-Based National Survey. International Journal of Hypertension, 2018, 5610725.

Preethi, S. P., & Hemachandran, T. (2019). Serum homocysteine as a predictor of severity of peripheral arterial disease in association with Doppler ultrasonography. International Surgery Journal, 6 (11), 3977-3981.

Rac-Albu, M., Iliuta, L., Guberna, S. M., & Sinescu, C. (2014). The Role of Ankle-Brachial Index for Predicting Peripheral Arterial Disease. MAEDICA-a Journal of Clinical Medicine, 9 (3), 295-302.

Rachmi, C. N., Li, M., & Baur, A. (2017). Overweight and obesity in Indonesia: prevalence and risk factors - a literature review. Public Health, 147, 20-29.

Rafie, A. H., Stefanick, M. L., Sims, S. T., Phan, T., Higgins, M., Gabriel, A., et al. (2010). Sex differences in the prevalence of peripheral artery disease in patients undergoing coronary catheterization. Vascular Medicine, 15 (6), 443-450.

Rosjidi, C. H., Isro’in, L., & Wahyuni, N. S. (2017). Difference in Risk Factor of Cardiovascular Disease Risk on Rural and Urban Population. KEMAS, 13 (1), 69-76.

Sartipy, F., Sigvant, B., Lundin, F., & Wahlberg, E. (2018). Ten Year Mortality in Different Peripheral Arterial Disease Stages : A Population Based Observational Study on Outcome. European Journal of Vascular & Endovascular Surgery, 55 (4), 529-536.

Sen, U., Mishra, P. K., Tyagi, N., & Tyagi, S. C. (2010). Homocysteine to Hydrogen Sulfide or Hypertension. Cell Biochemistry and Biophysics, 57 (2-3), 49-58.

Shammas, N. W. (2007). Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. Vascular Health and Risk Management, 3 (2), 229-234.

Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. Journal of the Royal Society of Medicine Cardiovascular Disease, 6, 1-9.

Vacek, T. P., Rehman, S., Neamtu, D., Yu, S., & Givimani, S. T. (2015). Matrix metalloproteinases in atherosclerosis: role of nitric oxide, hydrogen sulfde, homocysteine, and polymorphisms. Vascular Health and Risk Management, 11, 173-183.

Weragoda, J., Seneviratne, R., Weerasinghe, M. C., & Wijeyaratne, S. M. (2016). Risk factors of peripheral arterial disease: a case control study in Sri Lanka. BMC Research Notes, 9, 508.

World Health Organization. (2017, May 17). Cardiovascular Diseases (CVDs). Retrieved January 15, 2020, from World Health Organization:

Yang, Q., & He, G. W. (2019). Imbalance of Homocysteine and H2S: Significance, Mechanisms, and Therapeutic Promise in Vascular Injury. Oxidative Medicine and Cellular Longevity, 2019, 7629673.


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