No added value of the methionine loading test in assessment for venous thrombosis and cardiovascular disease risk

Miranda B. A. J. Keijzer; Petra Verhoef; George F. Borm; Henk J. Blom; Martin den Heijer

doi:10.1160/TH05-07-0498

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 95(02): 380-385
DOI: 10.1160/TH05-07-0498

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

No added value of the methionine loading test in assessment for venous thrombosis and cardiovascular disease risk

Miranda B. A. J. Keijzer

¹Department of Endocrinology, Radboud University Nijmegen Medical Centre

,

Petra Verhoef

²Wageningen Centre for Food Sciences and Wageningen University, Division of Human Nutrition, Wageningen

,

George F. Borm

³Department of Epidemiology and Biostatistics

,

Henk J. Blom

⁴Laboratory of Paediatrics and Neurology, Radboud University Nijmegen Medical Centre, The Netherlands

,

Martin den Heijer

¹Department of Endocrinology, Radboud University Nijmegen Medical Centre

³Department of Epidemiology and Biostatistics

› Author Affiliations

Abstract

Summary

Homocysteine isa risk factor for cardiovascular disease and venous thrombosis. Clinical guidelines differ in their recommendation whether or not to measure homocysteine after methionine loading. In this study, we investigated the added value of the methionine loading test next to fasting homocysteine levels for identifying subjects at risk for venous thrombosis or cardiovascular disease, using Receiver Operating Characteristic (ROC) curves.The analysis was performed in 185 patients with recurrent venous thrombosis, 130 patients with cardiovascular disease and 601 controls.The discriminatory power of the fasting homocysteine measurement alone for identifying subjects at risk of venous thrombosis expressed as the area under the ROC curve (AUC) was 0.61 (95%CI 0.56-0.66). Using both a fasting homocysteine measurement and a methionine loading test together yielded a similar AUC of 0.65 (95%CI 0.60-0.69), indicating no added value of methionine loading next to fasting homocysteine measurement in identifying subjects at risk for thrombosis. Similar results where found for cardiovascular disease, with anAUC of 0.62 (95%CI 0.57-0.67) for the fasting homocysteine measurement alone and an AUC of 0.62 (95%CI 0.57-0.67) for the combination of both the fasting and the postload homocysteine measurement. The methionine loading test has no added value next to measuring fasting homocysteine levels for identifying subjects at risk for venous thrombosis or cardiovascular disease and for that reason should not be used in clinical practice.

Keywords

Methionine loading test - hyperhomocysteinemia - homocysteine - venous thrombosis - ROC curve

Full Text

References

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