Professional Statements and Societal Positions Guidelines
Practice Guidelines and Position Statements
Cardiovascular Disease
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (2016) updated its guidance on risk assessment and reduction of cardiovascular disease (CVD), including lipid modification. The guidance asserted that full formal risk assessments should use a combination of risk assessment tools as well as informed clinical judgment. Homocysteine testing was not mentioned.
American Heart Association and American Stroke Association
The American Heart Association and the American Stroke Association (2014) issued joint guidelines on the primary prevention of stroke. These guidelines were endorsed by the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the Preventive Cardiovascular Nurses Association. The guidelines stated that individuals with hyperhomocysteinemia may be treated with B-complex vitamins to prevent ischemic stroke, but that the effectiveness was not clearly established (class IIb; level of evidence B).
American College of Cardiology and American Heart Association
The American College of Cardiology and the American Heart Association (2013) issued joint guidelines on the assessment of. These guidelines were endorsed by six (6) medical specialty associations. The guidelines developed multivariable equations to estimate age- and race-specific arteriosclerotic cardiovascular risk. The equations included age, total and high-density cholesterol levels, systolic blood pressure, antihypertensive treatment use, diabetes history, and current smoking status. The use of homocysteine screening for assessing the arteriosclerotic cardiovascular risk was not considered in these guidelines.
National Academy of Clinical Biochemistry
The National Academy of Clinical Biochemistry (2009) published guidelines on biomarkers for primary prevention of CVD. The Academy concluded that while homocysteine is a modest independent CVD risk factor, homocysteine screening for primary prevention and assessment in healthy individuals was unwarranted.
Venous Thromboembolism
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (2016) issued guidelines for effective quality improvement on preventing hospital-associated. The venous thromboembolism prevention protocol recommended involves a venous thromboembolism risk assessment, a bleeding risk assessment, and a clinical decision support on prophylactic choices. Homocysteine testing was not mentioned in these guidelines.
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (2018) issued guidance on reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Homocysteine testing was not mentioned in this guidance.
U.S. Preventive Services Task Force Recommendations
The U.S. Preventive Services Task Force (2009) issued a recommendation stating that the evidence was insufficient to assess the benefits and harms of using nontraditional risk factors to screen asymptomatic adults with no history of coronary heart disease to prevent coronary heart disease events. Homocysteine was one of the nontraditional risk factors considered in the recommendation. The Task Force (2018) issued an assessment of CVD risk with nontraditional risk factors. Homocysteine levels were not mentioned in this recommendation.
