Emergent Cardiovascular Risk Factor: Homocysteine

Cindy J. Warren, MSN, RN


Prog Cardiovasc Nurs. 2002;17(1) 

In This Article

The Role of Nurses

Cardiovascular nurses, armed with information about homocysteine, are well positioned to discuss hyperhomocysteinemia as an emerging risk factor for coronary artery disease with physicians, nurses, dietitians, patients, and the general public. While doing health assessments, patients can be identified who may be at risk of hyperhomocysteinemia. Assessment of dietary history for the adequacy of B vitamin intake is also important. A health history can help identify patients with diseases or who are taking medications known to elevate homocysteine. There are also other predisposing factors of high homocysteine that need to be recognized. For example, any person who has atherosclerotic vascular disease (ASVD) without conventional risk factors–a mother, father, brother, or sister younger than 60 with ASVD, multiple risk factors for ASVD, chronic renal failure, severe psoriasis, kidney or heart transplant–is at risk of having high homocysteine.[12] In addition, thyroid or estrogen deficiencies, inherited metabolic deficiencies, factor V Leiden, smoking, drinking excessive amounts of coffee,[14] inadequate intake of B vitamins, and epilepsy treated with antiseizure medication, may increase the risk of high homocysteine.[3,12] Once a patient at risk has been identified, referral to his or her physician would be appropriate ( Table 2 ).

Nurses and physicians discuss disease processes and patient outcomes frequently. Physicians may not have the time to discuss homocysteine, or may not test for homocysteine for a variety of reasons, such as cost. A discounted price for laboratory homocysteine testing may be negotiated if large numbers of samples are assayed for homocysteine. It is often less expensive if laboratories can process a large number of samples at once.

Dietitians, as members of the health care team, can also provide information about homocysteine and its relationship to B vitamins. They can individualize dietary counseling and design diets for those at risk of high homocysteine. Dietitians can collaborate with physicians and nurses by assessing dietary habits and making recommendations concerning nutritional approaches to prevent hyperhomocysteinemia. Discharge information can be prepared for patients identified at risk of high homocysteine, with examples of different kinds of foods containing B vitamins, and recommendations about taking B vitamin supplements (except in patients with pernicious anemia). Other important content would include suggestions about how to shop and prepare meals with rich sources of B vitamins.

In their roles as educators, cardiovascular nurses are often speakers at nursing conventions and seminars. In an effort to increase awareness about hyperhomocysteinemia, those who enjoy public speaking could offer to teach about homocysteine to groups of nurses in their own facilities and in other institutions that provide health care. Education about homocysteine can also include other hospital personnel, such as administrators, dietary and office personnel, and housekeeping staff.

Nurses can reach people with homocysteine information by other means, too. They can make posters about the topic to display on a bulletin board near the employee and visitor lunchrooms. Articles about homocysteine can be posted on bulletin boards in employee lounges. Cardiac rehabilitation nurses can also discuss homocysteine and the importance of B vitamins with patients and provide discharge information. Another approach for nurses to increase awareness about hyperhomocysteinemia would be to encourage the nursing education departments in hospitals to include the topic in orientation for new nurses.

Cardiovascular nurses can also be influential in the community. They can write editorials in local newspapers, give speeches at American Association of Retired Persons meetings, be guest speakers at local schools, and teach about homocysteine as parish nurses. Nurses can have a decisive impact on the dissemination of knowledge about homocysteine. They should also watch for the newest research findings as as they are published. Until the current intervention trials have been completed, nurses should encourage everyone to eat foods rich in B vitamins and encourage the use of supplemental B vitamins, especially persons identified as having a greater risk of having high homocysteine. Homocysteine awareness could be facilitated through the efforts of cardiovascular nurses.

Hyperhomocysteinemia is an emerging risk factor for coronary artery disease that can be easily identified with appropriate testing, and treated by dietary modification. Cardiovascular nurses, in partnership with physicians and dietitians, can assess, identify, and provide interventions for patients at risk for hyperhomocysteinemia. As educators, cardiovascular nurses can also increase awareness about hyperhomocysteinemia in their own practice settings as well as the community.


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