Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : October | Volume : 3 | Issue : 5 | Page : 1770 - 1775

Role of Homocysteine, Vitamins B6, B12 and Folic Acid in Acute Myocardial Infarction Patients

PASUPATHI P*, RAO Y Y **, FAROOK J **, BAKTHAVATHSALAM G **, BEJOY B ***, CHINNASWAMY P***, SARAVANAN G ****

*Institute of Laboratory Medicine & **Dept. of cardiology, K.G. Hospital and Post Graduate Medical Institute, ***Institute of Laboratory Medicine, Dept. of Clinical Biochemistry, Kovai Medical Center and Hospital (KMCH), [Coimbatore-641 014] ****Dept. of Biochemistry & Biotechnology, Faculty of Science, Annamalai University, [Annamalainagar-608002], Tamil Nadu, India

Correspondence Address :
Dr. P. Pasupathi, (Ph.D.),
H.O.D., Dept. of Clinical Biochemistry,
Institute of Laboratory Medicine, K.G. Hospital
and Post Graduate Medical Institute, Coimbatore-641018,
Tamil Nadu, (India). Tel: +91 422 2201201. Fax: +91 422 2211212.
E-mail: drppasupathi@gmail.com

Abstract

Background: Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction.
Methods: We investigated the possible correlation between deficiency of vitamins B6, B12 or folic acid and homocysteine in patients with acute myocardial infarction (AMI). A case control study was carried out involving 50 AMI patients and age matched 50 normal healthy subjects.
Results: Mean serum B12 concentration in AMI patients was found to be significantly lower than the mean for controls. Mean serum folate and PLP level in patients was also found to be lower than controls; however, the differences were not statistically significant. Mean plasma homocysteine level in AMI cases was higher than the mean level in controls. Compared to controls, there was significantly greater deficiency of folate, B12 and PLP in AMI patients.
Conclusion Substantial nutritional deficiencies of these three vitamins along with mild hyperhomocysteinemia, perhaps through interplay with the classical cardiovascular risk factors (highly prevalent in this population), could be further aggravating the risk of CAD in the population.

Keywords

Folic acid, vitamin B6, vitamin B12, homocysteine, AMI

Introduction
Cardiovascular disease (CVD) is the leading cause of death in both industrialized and developing countries. Recent reports have indicated that Indian people belong to an ethnic group, which has the highest rates of coronary artery disease (CAD) (1). Moreover, the relative risk of CAD in South Asian men is highest at early ages and suggesting that both intrinsic and extrinsic factors contribute to the development of CAD in this population (2), (3).
A number of studies during the past few years have indicated a protective role of vitamins B6, B12 and folate against the development of CAD (4), (5), (6). More recent reports have shown an association between deficiency of these B-complex vitamins and hyperhomocysteinemia, a known risk factor for myocardial infarction (7), (8). This has focused attention on these B-complex vitamins and the important role they might play in protection against the development of CAD (9).

The objective of this study is to investigate whether or not our patients suffering from acute myocardial infarction (AMI) have lower levels of plasma B6, B12 or folate and homocysteine compared to healthy subjects. If deficiency of B-complex vitamins is found to exist in this population, then intervention in the form of supplementations might significantly reduce the incidence of CAD.

Material and Methods

Study Population
The populations of study consider two hundred subjects, divided in two groups. Hundred AMI patients (age 30–70 years) admitted to the Kovai Medical Centre and Hospital (KMCH) & K.G. Hospital and Post Graduate Medical Institute Tamil Nadu from January 2007 to February 2008 were included in this study. They were enrolled within the index admission after confirmation of diagnosis based on WHO criteria of clinical history suggestive of myocardial ischemia, ECG indications of myocardial damage, and elevation of biochemical markers (creatine kinase and creatine kinase-MB). All patients were assessed as having risk factors for CVD, such as diabetes mellitus, hypertension, obesity, hypercholesterolemia, smoking and a parental history of ischemic heart disease (IHD). Criteria for diabetes were set as an abnormal fasting blood glucose level >125 mg/dl at admission, or having taken hypoglycemic agents. All those with systolic blood pressure greater than 140 mmHg and/or diastolic blood pressure of 90 mmHg or those on regular anti-hypertensive medications were classified as hypertensive. Those having serum cholesterol level greater than 200 mg/dl were considered to have hypercholesterolemia. A body mass index (BMI) above 30 was classified as obese, and a parental history of IHD was considered positive if any of the parents had IHD at or below the age of 60 years. Subjects were considered smokers if they had been smoking cigarettes regularly (one or more per day). Those cases (as well as controls) that were pregnant, using anti-epileptics, taking oral contraceptives, having malabsorption syndrome, suffering from tuberculosis, liver disease, uremia, or cancer or using vitamin B-complex supplements during the past 6 months were not included.
Similarly, age and sex matched 100 normal healthy subjects were also investigated. They were also assessed for the above-mentioned risk factors. However, more stringent criteria were used for the selection of normal healthy control subjects. In addition to being matched for age, sex and socioeconomic background, they had no evidence of CAD, diabetes mellitus, hypertension, obesity or hypercholesterolemia. The objective was to have an assessment of the levels of folate, B12, B6 and homocysteine in a “normal healthy population” and compare their levels with those obtained from AMI patients.

Estimation of Biochemical Investigation
Biochemical investigation including blood glucose fasting, total cholesterol, triglycerides, HDL, LDL and CK levels were determined by fully automated clinical chemistry analyzer (Hitachi 912, Boehringer Mannheim, Germany). VLDL level was calculated according to Friedewald et al. (10) CK-MB mass were measured with highly specific monoclonal antibodies in a sensitive chemiluminescence assay, with an Elecsys 2010 instrument (Roche Diagnostics, Mannheim, Germany). Troponin I level was estimated using fully automated immunoassay analyzer (AXSYM-Abbott Laboratories, Abbott Park, USA).

Estimation of B12, folate, B6 and homocysteine in serum/plasma
Fasting venous blood was obtained from cases as well as controls. Serum samples were analyzed for folate and vitamin B12 using radio assays [11,12]. Plasma samples from both cases and controls were screened for pyridoxal phosphate (PLP; coenzymic form of vitamin B6) and homocysteine. Plasma PLP concentration was chosen as the standard for vitamin B6 status because this measure appears to reflect tissue stores Lui (13). For determination of PLP in plasma, a modification of the method by Camp et al. (14) as described previously was used Iqbal et al (15). Determination of plasma homocysteine was carried out using a kit based on fluorescence polarization immunoassay (Abbott Laboratories, Ltd., USA).

Statistical Analysis
All data were expressed as mean ± SD. The statistical significance was evaluated by Student’s t test using Statistical Package for the Social Sciences (SPSS Cary, NC, USA) version 10.0.

Results

Demographic data of control and AMI group are shown in (Table/Fig 1). The mean age limit was 47.5 ± 12.5 years in AMI patients and 43.7 ± 10.3 years in control subjects. The increased body mass index (BMI) in AMI patients (28.8 ± 4.2 kg/ m2) when compared to control subjects (23.2 ± 3.7 kg/ m2) was statistically significant. Blood Pressure systolic blood pressure was significantly high (p<0.05) in patients groups as compared with controls.

The comparison of biochemical changes in control and MI subjects are shown in (Table/Fig 2). As expected, the patients had significantly higher level of total cholesterol, triglyceride, LDL-cholesterol and VLDL-cholesterol when compare to control subjects, but HDL-cholesterol in AMI patients was significantly less than in normal healthy subjects. There was no statistical significant in fasting blood glucose. The significantly increases in the level of CK, CK-MB seen in MI patients when compare to control subjects.

(Table/Fig 3) shows the mean concentrations of serum folate, serum B12, plasma PLP and plasma homocysteine in normal healthy subjects (controls) and AMI patients. Analysis the mean serum B12 concentration in AMI patients was significantly less than in normal healthy subjects. Mean serum folate level in AMI patients was found to be lower than the mean level in normal healthy control subjects. Mean plasma PLP concentration in AMI patients was also found to be lower than the controls, however, the values were not significantly different. Mean homocysteine concentration in plasma of AMI patients was higher compared to controls (11.2±4.02 μmol/l vs 19.5 ±7.85 μmol/l).

Discussion

Significantly high percentages of folate, B6, and B12 deficiencies in AMI patients in our study population suggest a causal relationship between nutritional deficiency of these vitamins and development of CAD. The high prevalence of folate and B6 deficiencies in our control group was quite unexpected. With hardly any data available on deficiency of these two vitamins in the general population, our results indicate that folate and B6 deficiencies could be quite common. High prevalence of folate deficiency in our normal as well as patient populations could be due to our urban dietary habits, which include inadequate use of fresh fruit and vegetables and overcooking. There has been a considerable debate on the value of plasma PLP which should be taken as standard for adequate B6 status (16).

Although a mild hyperhomocysteinemia has been observed in our patients suffering from AMI, it does not appear to be an independent risk factor for development of CAD. The causes of hyperhomocysteinemia are multifactorial, but our preliminary data indicate that folate deficiency and B6 deficiency certainly appear to have an association with it. This could be due to the fact that most of the subjects in our cases and control populations belonged to the lower middle class, a group with a relatively modest socio-economic background and perhaps receiving somewhat poor and unbalanced nutrition (3).

A number of studies have shown increased plasma homocysteine levels in aged individuals (17), (18). Our observation of significantly lower levels of serum folate in smokers compared to nonsmokers in the normal control group, as well as in the AMI patients group, is consistent with the results reported by Mansoor et al. (19) who showed a significant decrease in both serum and erythrocyte folate in smokers. Lower intake of fruit and vegetables, free radicals in cigarette smoke, and increased excretion of folate might have contributed to a decline in body stores of folate (20). With low folate and low B12 concentrations in smokers, mean plasma homocysteine concentrations among smokers (both in controls as well as AMI patients), as expected, were found to be significantly higher than in nonsmokers. Nygard et al. (21) in a study involving nearly 16,000 subjects from a general community in Norway have also reported significantly increased levels of total homocysteine in smokers compared to nonsmokers.

On the basis of these observations, it can be suggested that very significant deficiencies of folate, B6 and B12 along with mild hyperhomocysteinemia could act synergistically in concert with other classical risk factors in the study- population, thereby further aggravating the risk of CAD.

Our study reports the prevalence of folate, B6 and B12 deficiency and its relationship with plasma homocysteine levels. Our data show substantial nutritional deficiency of all these three vitamins. Deficiencies of folate, B6 and B12 were even more pronounced in AMI patients, consistent with their important role in preventing the development of CAD. Any single nutritional intervention, such as supplementation with folate alone, may not be enough to protect against CAD in a population that has the highest rates of this disease compared to any other in the world. However, supplementations with all three vitamins would, perhaps, offer some protection. The association between B-complex vitamin deficiency, hyperhomocysteinemia, other classical risk factors and the risk of developing CAD merits our serious attention.

References

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Ranucci M, Ballotta A, Frigiola A, Boncilli A, Brozzi S, Costa E, Mehta R H. Pre-operative homocysteine levels and morbidity and mortality following cardiac surgery. Eur Heart J 2009; 30: 995-1004.
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Iqbal MP, Ishaq M, Kazmic KA, Yousuf FA, Mehboobali N, Ali SA, Khan AH, Waqar MA. Role of vitamins B6, B12 and folic acid on hyperhomocysteinemia in a Pakistani population of patients with acute myocardial infarction. Nutrition Metabolism and Cardiovascular Diseases 2005; 15: 100e-108e.
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Hodis HN, Mack WJ, Dustin L, Mahrer PR, Azen SP, Detrano R, Selhub J, Alaupovic P, Liu C, Liu C, Hwang J, Wilcox AG, Selzer RH, for the BVAIT Research Group. High-Dose B Vitamin Supplementation and Progression of Subclinical Atherosclerosis: A randomized controlled trial. Stroke 2009; 40: 730-36.
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Verhoef P, Stampfer MJ, Buring JE, Gaziano JM, Allen RH, Stabler SP. Homocysteine metabolism and risk of myocardial infarction: relation with vitamins B6, B12 and folate. Am J Epidemiol 1996; 143: 845-59.
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Bonaa KH, Njolstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, Wang H, Nordrehaug JE, Arnesen E, Rasmussen K, the NORVIT Trial Investigators. Homocysteine Lowering and Cardiovascular Events after Acute Myocardial Infarction. NEJM 2006; 354: 1578-88.
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Nishtar S. The role of vitamins as risk modifying agents in coronary artery disease. Pak J Cardiol 1999; 10: 5-7.
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Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry1972; 18: 499-502.
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Rothenberg SP, daCosta M, Rosenberg Z. A radioassay for serum folate: use of a two-phase sequential incubation, ligand-binding system. N Engl J Med 1972; 286:1335-ss39.
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Rothenberg SP. Application of competitive ligand binding for the radioassay of vitamin B12 and folic acid. Metabolism 1973; 22: 1075-82.
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Lui A, Lumeng L, Aronoff GR, Li TK. Relationship between body store of vitamin B6 and plasma pyridoxal-P clearance: metabolic balance studies in humans. J Lab Clin Med 1985; 106: 491-97.
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Camp VM, Chipponi J, Faraj BA. Radioenzymatic assay for direct measurement of plasma pyridoxal 5′-phosphate. Clin Chem1983; 29: 642-44.
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