Homocysteinemia Level Determination Among Retired People in Bobo Dioulasso, Burkina Faso

Homocysteinemia Level Determination Among Retired People


Introduction
Among elderly people, hyperhomocysteinemia, currently considered as a public health problem, has long been associated with the occurrence of neurodegenerative diseases [1], cognitive decline and dementia [2], and cardiovascular diseases [3]. Previous work by Simporé et al. in 2000 showed that homocysteinemia was low in general population in Burkina Faso. Plasma homocysteine levels were lower in black adults and children, particularly women, compared to white subjects [4]. Older postmenopausal women had higher mean homocysteine levels (16.4±6.6 mmol/L) than fertile women (6.8±1.2 mmol/L) [5]. Hyperhomocysteinemia can occur from genetic enzymatic deficiencies in 5, 10-methylenetetrahydrofolate reductase (MTHFR) or cystathionine-β-synthase (CBS) [6] or nutritional deficiencies in B vitamins [7]. One therapeutic strategy to address homocysteine excesses is vitamin B supplementation with drugs to treat the deficiency frequently present in elderly people [8]. Among retired elderly people in Bobo Dioulasso, often subject to a very precarious socioeconomic life, we found a high frequency of acute denutrition [9]. Regarding the significant association of hyperhomocysteinemia with the occurrence of major pathologies, we aimed to determine the homocysteinemia levels in retired people in Bobo Dioulasso.

Study Population
This is a cross-sectional study. Study population consisted of retired persons. An exhaustive sampling was carried out following inclusion criteria: being a retired person from the public or private sector; being a volunteer and signed an informed consent; resident in Bobo dioulasso in the western part of Burkina Faso.

Blood Samples and Biochemical Parameters
Retired persons were fasting for at least 12 hours. Whole blood, collected in a dry tube, was centrifuged to collect serum for total homocysteinemia determination by a microparticle chemiluminescence immunoassay (CMIA); immunoturbidimetric determination for Lp (a), cystatin C, prealbumin and CRP using Architect Ci4100® (Abbott Diagnostics, USA).

Ethical Considerations
Informed consent was obtained from all retired persons included in this study. They were alerted about the risk factors for hyperhomocysteinemia and its outcomes, including cardiovascular disease and dementia. Their participation was completely voluntary. Biological samples were well labeled and all data were processed in anonymity.

General Characteristics of the Study Population
We included 71 retired persons, consisting of 13 women and 58 men, with a sex ratio of 4.46. Their median age was 64 years [minimum -maximum: 45 -92 years]. They had a normal general condition and a normal state of consciousness.

Discussion
This study might be limited by its cross-sectional design and bias in qualitative data collection from retired seniors. There is a relatively low frequency of 16.90% of moderate hyperhomocysteinemia in our study population. Moderate hyperhomocysteinemia frequencies of 62.3% and 29.4% were recorded in Togo and Benin respectively [12]. Among elderly persons with median age of 55 years in China, hyperhomocysteinemia had a frequency of 35.4% (45.4% versus 28.5% for men and women, respectively) [13]. Moderate hyperhomocysteinemia was not significantly associated with sex, age, denutritional status, or glomerular filtration rate. Similarly, in West Africa, particularly in Togo and Benin, moderate hyperhomocysteinemia was not significantly associated with sex or age [12]. Yang et al, (2021) in a cross-sectional study, revealed a significant association between active smoking, male sex, age, alcohol consumption and high BMI and the risk of hyperhomocysteinemia. However, he nuanced these results by suggesting cohort studies to further confirm these findings [13]. Risk of hyperhomocysteinemia increasing with age had been previously discussed [14].
A median homocysteinaemia value in our study was 18.71 µmol/L for those with hyperhomocysteinemia. Studies report an association between the onset of dementia, cardiovascular disease and increased homocysteinemia over 14 µmol/L [15]. Overall, our study population was apparently mentally healthy and somewhat more at risk for cardiovascular disease. Compared to white adults, Simporé et al. (2000) reported lower homocysteinemia usual values, as determined by high performance liquid chromatography, in black adults. In addition, limits for usual homocysteinemia values were higher in black men than in black women [4].
Risk of hyperhomocysteinemia is significantly associated with male sex [13,15]. Testosterone control of cystathionine β-synthase (CBS) enzymatic activity, an enzyme involved in homocysteine catabolism in kidney, would explain this in humans [16]. Severe denutrition frequency was observed at 91.66% (11/12) but not significantly associated (p=0.882) with hyperhomocysteinemia. Wang et al. (2013) reported that a BMI ≥ 25kg/m 2 is significantly associated with a risk of hyperhomocysteinemia. Median age for hyperhomocysteinemia cases was significantly higher (48.00 years) compared to median age (45.00 years) for control group [17]. Smokers were significantly higher in hyperhomocysteinemia cases than in control group [17]. However, in previous studies conducted in Burkina Faso by Rosa et al (2005), [5] mean homocysteinemia in postmenopausal women aged 50 to 90 years were higher (16.4±6.6 µmol/L) than in fertile women (6.8±1.2 µmol/L). Moderate hyperhomocysteinemia, which may be due to a deficiency of group B vitamins in adult persons [18]. These molecules are all associated with homocysteine metabolism.
Furthermore, genetic hyperhomocysteinemias are most severe. Djaara et al., (2019) [19] showed a highly significant association of moderate hyperhomocysteinemia related to male sex and C677T polymorphism of MTHFR gene in an Algerian healthy population. Meanwhile, A1298C polymorphism was not significantly associated with moderate hyperhomocysteinemia [19]. Yameogo et al. (2017) [20], in Burkina Faso, had detected C677T, A1298C, A2756G and A66G polymorphism of the MTHFR gene in malaria patients.

Conclusion
This study revealed a relatively low frequency of moderate hyperhomocysteinemia in retired people in Bobo Dioulasso. Neither modifiable nor non-modifiable risk factors were significantly associated with hyperhomocysteinemia. Genetic polymorphisms associated with hyperhomocysteinemia could be investigated to prevent severe forms.