Homocyst(e)ine, atherosclerosis, and thrombosis.

Ample clinical and epidemiologic evidence exists to implicate homocyst(e)ine as a risk factor for atherosclerotic vascular disease and thrombosis. The precise mechanisms by which this occurs are uncertain but probably involve injury to endothelium, impairment of endothelial function, lipid peroxidation, oxidation of low-density lipoprotein, and creation of a prothrombotic environment in areas of endothelial injury. Plasma homocyst(e)ine concentration (PHC) can be effectively reduced with oral administration of folic acid. Whether vitamins B6 and B12 are also required in the absence of vitamin deficiency remains uncertain. Studies currently in progress may help to determine whether reduction of PHC will translate into a decrease in clinical vascular events.     

NSAID ulcer (H. pylori, treatment, prevention)

Although it has been reported that NSAID ulcer has been increasing in western countries, the epidemiology and treatment or prevention of this type of peptic ulcer have not been fully studied. Recently 'Guideline for the treatment of gastric ulcer' has been published in Japan. Based on the data described in the guideline, at present it is recommended to use misoprostol, protonpump inhibitor, or high dose of H2 receptor in the prevention of NSAID ulcer. In the treatment of NSAID ulcer, to stop NSAID and/or to use misoprostol or protonpump inhibitor are recommended.