|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2003; 41:2105-2113, doi:10.1016/S0735-1097(03)00485-6 © 2003 by the American College of Cardiology Foundation |
* Department of Cardiology, Oosterschelde Ziekenhuizen, Goes, The Netherlands
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Leiden University Medical Center, Leiden, The Netherlands
University Hospital, Groningen, The Netherlands
* Reprint requests and correspondence: Dr. Anho Liem, Department of Cardiology, Oosterschelde Ziekenhuizen, Postbus 106, 4460BB Goes, The Netherlands.
anho{at}zeelandnet.nl
OBJECTIVES: We sought to conduct a randomized trial with folic acid 0.5 mg/day in a patient population with stable coronary artery disease (CAD).
BACKGROUND: Folic acid has favorable effects on vascular endothelium and lowers plasma homocysteine levels. In addition, homocysteine appears to be an independent risk factor for atherosclerotic disease. However, the value of folic acid in secondary prevention had seldom been tested.
METHODS: In this open-label study, 593 patients were included; 300 were randomized to folic acid and 293 served as controls. Mean follow-up time was 24 months. At baseline all patients had been on statin therapy for a mean of 3.2 years.
RESULTS: In patients treated with folic acid, plasma homocysteine levels decreased by 18%, from 12.0 ± 4.8 to 9.4 ± 3.5 µmol/l, whereas these levels remained unaffected in the control group (p < 0.001 between groups). The primary end point (all-cause mortality and a composite of vascular events) was encountered in 31 (10.3%) patients in the folic acid group and in 28 (9.6%) patients in the control group (relative risk 1.05; 95% confidence interval: 0.63 to 1.75). In a multifactorial survival model with adjustments for clinical factors, the most predictive laboratory parameters were, in order of significance, levels of creatinine clearance, plasma fibrinogen, and homocysteine.
CONCLUSIONS: Within two years, folic acid does not seem to reduce clinical end points in patients with stable coronary artery disease (CAD) while on statin treatment. Homocysteine might therefore merely be a modifiable marker of disease. Thus, low-dose folic acid supplementation should be treated with reservation, until more trial outcomes become available.
| ||||||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  J. F. E. Mann, P. Sheridan, M. J. McQueen, C. Held, J. M. O. Arnold, G. Fodor, S. Yusuf, E. M. Lonn, and on behalf of the HOPE-2 investigators Homocysteine lowering with folic acid and B vitamins in people with chronic kidney disease--results of the renal Hope-2 study Nephrol. Dial. Transplant., February 1, 2008; 23(2): 645 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Shirodaria, C. Antoniades, J. Lee, C. E. Jackson, M. D. Robson, J. M. Francis, S. J. Moat, C. Ratnatunga, R. Pillai, H. Refsum, et al. Global Improvement of Vascular Function and Redox State With Low-Dose Folic Acid: Implications for Folate Therapy in Patients With Coronary Artery Disease Circulation, May 1, 2007; 115(17): 2262 - 2270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Hao, J. Ma, J. Zhu, M. J. Stampfer, Y. Tian, W. C. Willett, and Z. Li High Prevalence of Hyperhomocysteinemia in Chinese Adults Is Associated with Low Folate, Vitamin B-12, and Vitamin B-6 Status J. Nutr., February 1, 2007; 137(2): 407 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nasir, M. Tsai, B. D. Rosen, V. Fernandes, D. A. Bluemke, A. R. Folsom, and J. A.C. Lima Elevated Homocysteine Is Associated With Reduced Regional Left Ventricular Function: The Multi-Ethnic Study of Atherosclerosis Circulation, January 16, 2007; 115(2): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Antoniades, C. Shirodaria, N. Warrick, S. Cai, J. de Bono, J. Lee, P. Leeson, S. Neubauer, C. Ratnatunga, R. Pillai, et al. 5-Methyltetrahydrofolate Rapidly Improves Endothelial Function and Decreases Superoxide Production in Human Vessels: Effects on Vascular Tetrahydrobiopterin Availability and Endothelial Nitric Oxide Synthase Coupling Circulation, September 12, 2006; 114(11): 1193 - 1201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kaul, A. A. Zadeh, and P. K. Shah Homocysteine Hypothesis for Atherothrombotic Cardiovascular Disease: Not Validated J. Am. Coll. Cardiol., September 5, 2006; 48(5): 914 - 923. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. W. Rice and A. B. Lumsden Optimal Medical Management of Peripheral Arterial Disease Vascular and Endovascular Surgery, August 1, 2006; 40(4): 312 - 327. [Abstract] [PDF]
|
|
|
|
 |
|
 K. H. Bonaa, I. Njolstad, P. M. Ueland, H. Schirmer, A. Tverdal, T. Steigen, H. Wang, J. E. Nordrehaug, E. Arnesen, K. Rasmussen, et al. Homocysteine Lowering and Cardiovascular Events after Acute Myocardial Infarction N. Engl. J. Med., April 13, 2006; 354(15): 1578 - 1588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Heart Outcomes Prevention Evaluation (HOPE) 2 Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease N. Engl. J. Med., April 13, 2006; 354(15): 1567 - 1577. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J Stott, G. MacIntosh, G. D. Lowe, A. Rumley, A. D McMahon, P. Langhorne, R C. Tait, D. S. J O'Reilly, E. G Spilg, J. B MacDonald, et al. Randomized controlled trial of homocysteine-lowering vitamin treatment in elderly patients with vascular disease Am. J. Clinical Nutrition, December 1, 2005; 82(6): 1320 - 1326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Liem, G H Reynierse-Buitenwerf, A H Zwinderman, J W Jukema, and D J van Veldhuisen Secondary prevention with folic acid: results of the Goes extension study Heart, September 1, 2005; 91(9): 1213 - 1214. [Full Text] [PDF]
|
|
|
|
|
|
J. H.K. Vogel, S. F. Bolling, R. B. Costello, E. M. Guarneri, M. W. Krucoff, J. C. Longhurst, B. Olshansky, K. R. Pelletier, C. M. Tracy, R. A. Vogel, et al. Integrating Complementary Medicine Into Cardiovascular Medicine: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine) J. Am. Coll. Cardiol., July 5, 2005; 46(1): 184 - 221. [Full Text] [PDF]
|
|
|
|
 |
|
 P.W Serruys and J Aoki Therapeutic options for patients with chronic myocardial ischaemia Eur. Heart J. Suppl., September 1, 2004; 6(suppl_E): E2 - E11. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. J. Moat, S. N. Doshi, D. Lang, I. F. W. McDowell, M. J. Lewis, and J. Goodfellow Treatment of coronary heart disease with folic acid: is there a future? Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H1 - H7. [Full Text] [PDF]
|
|
|
|
|
|
K. Robinson Renal Disease, Homocysteine, and Cardiovascular Complications Circulation, January 27, 2004; 109(3): 294 - 295. [Full Text] [PDF]
|
|
|
|
 |
|
 Other articles noted Evid. Based Med., January 1, 2004; 9(1): 31 - 32. [Full Text] [PDF]
|
|
|
|
 |
|
 Folic Acid Not Beneficial for Secondary Coronary Prevention Journal Watch Gastroenterology, September 30, 2003; 2003(930): 9 - 9. [Full Text]
|
|
|
|
 |
|
 Folic Acid Not Beneficial for Secondary Coronary Prevention Journal Watch (General), August 15, 2003; 2003(815): 3 - 3. [Full Text]
|
|
|
|
 |
|
 Folic Acid Not Beneficial for Secondary Prevention Journal Watch Cardiology, August 8, 2003; 2003(808): 4 - 4. [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
