A. Medical Conditions
Homocysteine levels have been noted to increase soon after an acute MI or stroke along with occurrence of the conditions listed below.
• Renal failure
• Hypothyroidism
• Some forms of cancer
• Inflammatory bowel disease
• Rheumatoid disease
• Psoriasis
• The post-transplant state
• Vitamin B12 deficiency
• Folate deficiency
• MTHFR gene deficiency.
A polymorphism in the MTHFR gene results in a thermolabile enzyme associated with elevated homo¬cysteine levels. The prevalence of this mutation is low in Asian-Indians and Africans ranging from 0 to 2% vs. 10 to 20% in other populations.
B. Medications
Several medications can cause elevation of homocysteine levels. These include drugs that interfere with the:
• functional vitamin B6: niacin, theophylline, isoniazid
• functional vitamin B12: cholestyramine, colestipol, metformin
• function of folate: anticonvulsants, methotrexate.
C. Lifestyle Behaviors
Lifestyle behaviors that increase homocysteine levels are heavy alcohol consumption, excessive coffee consumption, cigarette smoking, and physical inactivity.