Abstract

Recent data on the atherogenic effect of elevated concentrations of homocysteine (Hcy) and a review of published results on the influence of sex hormones, especially estrogens, on plasma Hcy levels are presented. Epidemiological data show that hyperhomocysteinemia as well as a mild elevation in plasma Hcy levels significantly increase cardiovascular risk. Some results do not support this relationship. Recently it was established that onset of menopause and decreases in serum estrogen levels probably increase serum Hcy concentrations. The majority of investigation, based on observational studies and the results of one randomized, double-blind placebo-controlled study, showed that use of estrogen and hormonal replacement therapy lowered HCY concentration. It has been observed that the decrease in Hcy level was greater the higher its concentrations before treatment. These results are in contrast with those of another randomized double-blind placebo-controlled study which showed that the Hcy concentration does not depend on menopause and does not change after hormonal treatment. Individual data showed that dehydroepiandrosterone, an adrenal steroid, probably lowers Hcy level. There were no correlations between serum Hcy concentration and insulin concentration, body mass, and type of obesity. The hypotheses about the influence of sex hormones on Hcy concentration are not clear and need further investigation.

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