Screening for homocysteine levels in Israel in primary care clinics: A need for guidelines

Background. Elevated total homocysteine (tHcy) levels (≥ 15 μmol/L), resulting from enzyme or vitamin deficiency, increase risk for cardiac, cerebral, and peripheral vascular disease. This study examines tHcy levels in an Israeli population and the relationship to vitamin status and disease. The need for screening guidelines is discussed. Methods. Fasting blood was tested for tHcy levels in 262 patients (141 male, 121 female) presenting to two primary care clinics. Levels of folic acid and vitamin B12 were examined as well. Results. Elevated tHcy levels (≥ 15 μmol/L) were found in 43 of the males (30.5%) and four of the female patients (3.3%, P < 0.005), while females had higher levels of both vitamin B12 and folic acid. Those with elevated tHcy levels tended to be older and with lower vitamin levels, with a higher frequency of coronary artery disease. Conclusions. Screening for tHcy and fortification of grain products with folic acid is a cost-effective means for preventing disease. Serum tHcy levels are inversely related to vitamin status, and higher levels among males is thought to be due to metabolic differences between the genders. Guidelines for screening for tHcy in Israel should be established, and fortification of grain products implemented.