Total plasma homocysteine and restenosis after percutaneous coronary angioplasty: current evidence

Ann Med. 2003;35(3):156-63. doi: 10.1080/07853890310008206.


Background: Restenosis after percutaneous coronary angioplasty (PTCA) remains an important limitation of this procedure.

Aim: To assess the relationship between homocysteine levels and restenosis after PTCA, and discuss the potential benefit of homocysteine-lowering therapy.

Method: MEDLINE-based literature review.

Results: The conflicting literature on the association between homocysteine levels and restenosis after PTCA can partially be explained by differences in methodology. Depending on the type of studies considered, a pooling of data resulted in a 22%-36% risk reduction of restenosis in lesions exposed to low homocysteine levels. The strongest reduction was found in balloon-only treated lesions (42%), while only a trend (14%) was seen in stented lesions. Based on the only available trial, homocysteine-lowering therapy yielded a 54% restenosis rate reduction, 76% in balloon-only treated lesions and 31% in stented lesions. Furthermore, homocysteine-lowering therapy provided a significant clinical benefit with a 40% relative reduction in major adverse events at 6 months' follow-up.

Conclusions: This review suggests that plasma homocysteine is a modifiable risk factor for restenosis, which when lowered improves outcome after PTCA. This inexpensive treatment with virtually no side-effects could therefore be considered as adjunctive therapy for patients undergoing PTCA, while awaiting results from further studies.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary / adverse effects*
  • Biomarkers / blood
  • Coronary Restenosis / blood*
  • Coronary Restenosis / etiology*
  • Coronary Restenosis / physiopathology
  • Coronary Restenosis / prevention & control
  • Folic Acid / therapeutic use
  • Homocysteine / blood*
  • Humans
  • Risk Assessment / methods
  • Risk Factors
  • Treatment Outcome
  • Vitamin B 12 / therapeutic use
  • Vitamin B 6 / therapeutic use


  • Biomarkers
  • Homocysteine
  • Vitamin B 6
  • Folic Acid
  • Vitamin B 12