Determinazione dell'omocisteina plasmatica: Indicazioni per la richiesta = Determination of plasma homocysteine: Recommendations for test requesting

Determination of plasma homocysteine: recommendations for test requesting. High plasma homocysteine concentrations can be caused by various factors, including low blood concentrations of B-complex vitamins. Hyperhomocysteinemia is widely believed to be associated with an increased risk of atherosclerotic disease; recent emerging evidence made, however, doubtful its role as cardiovascular risk factor. The aim of this document was to examine the appropriateness of homocysteine requesting in our clinical setting. Clinical guidelines, meta-analyses and systematic reviews were used as source of high level evidence. During the last two decades, the role of hyperhomocysteinemia was examined in a number of clinical conditions; however, the analysis of available data made us clear that determination of plasma homocysteine has only limited clinical role. Test requesting results to be appropriate only in case of suspected homocystinuria (an inherited disorder of the metabolism of the amino acid methionine), in patients with previous venous or arterial thromboembolism and in patients with severe (>100 µmol/L) [and possibly moderate (>30 µmol/L)] hyperhomocysteinemia treated with B-complex vitamins. Determination of plasma homocysteine is not recommended as a primary prevention tool for cardiovascular disease in the general population.