Subclinical carotid artery disease and plasma homocysteine levels in patients with hypertension

•Emerging cardiovascular risk factors contribute to organ damage in hypertension•We investigated the relationship of Hcy with subclinical carotid artery disease•Carotid intima–media thickness was independently related to plasma Hcy levels•Plasma Hcy level was independent predictor of presence of carotid plaques•Elevated Hcy contributes to asymptomatic carotid disease in hypertension

Information on the association between homocysteine (Hcy) levels and subclinical carotid artery disease is limited. We investigated the relationship of plasma Hcy concentration with carotid artery plaques and intima–media thickness (IMT) in patients with hypertension. In 486 essential hypertensive patients who underwent ultrasound examination of the carotid arteries, we measured plasma levels of Hcy, vitamin B12, folate, and C–reactive protein. Plaques were detected in 34% of the study patients. Plasma Hcy levels were significantly greater in hypertensive patients with evidence of carotid plaques than patients without carotid plaques. Carotid IMT progressively increased across quartiles of plasma Hcy levels. Multivariate regression showed that carotid IMT was independently related with age, blood pressure, C–reactive protein, and Hcy levels. In a logistic regression, age, blood pressure, triglyceride, and Hcy independently predicted the presence of carotid plaques. Thus, elevated plasma Hcy levels are associated with asymptomatic carotid disease in hypertensive patients suggesting a role of Hcy in the development and progression of carotid atherosclerosis in these patients.