One-carbon metabolism markers in cardiac patients at different times after a new coronavirus infection

Introduction. The development of postCOVID syndrome is accompanied by changes in one-carbon metabolism and the development of cardiovascular diseases in patients who have undergone a new coronavirus infection. To understand the pathogenesis of postCOVID syndrome in patients with cardiological pathology, it is important to study possible biochemical changes, as well as to search for predictors to assess the risk of cardiovascular pathology.

Objective – to evaluate changes in homocysteine and folic acid levels at different times after a new coronavirus infection in patients with cardiovascular diseases.

Material and Methods. The case-control study included 82 patients of the cardiology department, of which 49 patients at different times after COVID-19 (6 months, 12 months and 24 months) and 33 patients without a history of COVID-19 (control). Serum concentrations of homocysteine and folic acid were determined in all patients.

Results. In cardiac patients with COVID-19, regardless of the prescription period, the concentration of homocysteine was 11.1 [9.3; 14.2] mmol/l, in the control – 13.9 [12.0; 16.9] mmol/l (p=0.013). At the same time, the folic acid content in the group of patients who underwent Covid-19 was statistically significantly lower than in the group of patients who did not have COVID-19 (6.52 [4.26; 8.86] and 11.0 [8.08; 12.3] ng/ml, respectively). When analyzing homocysteine levels depending on the prescription period after COVID-19, after 6 months, the homocysteine level was 9.4 [8.3; 13.7] mmol/l, after 12 months – 10.3 [9.2; 10.6] mmol/l, after 24 months – 13.2 [11.2; 17.2] mmol/l, p=0.004. The concentration of folic acid in patients 6 months after COVID-19 was 6.13 [3.36; 8.68] ng/ml, after 12 months – 10.1 [5.63; 16.1] ng/ml, after 24 months – 5.82 [5.44; 8.06] ng/ml, p=0.08. At the time 24 months after the COVID-19, the homocysteine/folic acid ratio was higher than at other times, indicating an imbalance in one-carbon metabolism.

Conclusion. Hyperhomocysteinemia is observed in patients with cardiovascular pathology, regardless of the coronavirus infection. After COVID-19 in patients with a cardiological profile, disorders in single-carbon metabolism, manifested by folic acid deficiency and hyperhomocystenemia, underlie the development of long COVID and are predictors of cardiovascular complications.