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High-Dose Folic Acid Acutely Improves Coronary Vasodilator Function in Patients With Coronary Artery Disease

Ahmed Tawakol, MD^_*,_*, Raymond Q. Migrino, MD, Kusai S. Aziz, MD^_*, Justyna Waitkowska, MD^_*, Gotfred Holmvang, MD^_*, Nathaniel M. Alpert, PhD, James E. Muller, MD^_*, Alan J. Fischman, MD, PhD and Henry Gewirtz, MD^_*

^_* Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Boston, Massachusetts
Department of Radiology, and Nuclear Medicine, Massachusetts General Hospital, Boston, Massachusetts

View larger version (19K): [in a new window]   Figure 1 Effect of high-dose folate on mean arterial pressure (MAP). Resting MAP was measured. Individual responses are shown, and group mean data (± SD) are depicted by the thick line. Folate significantly reduced MAP (100 ± 3 mm Hg vs. 96 ± 2 mm Hg, placebo vs. folate, p < 0.03).

View larger version (20K): [in a new window]   Figure 2 Effect of high-dose folate on peak (adenosine-stimulated) myocardial blood flow (MBF). Peak adenosine-stimulated MBF was measured in abnormal zones. Individual responses are shown, and group mean data are depicted by the thick line. Folate significantly increased peak MBF (1.45 ± 0.59 ml/min/g vs. 2.16 ± 1.01 ml/min/g, mean ± SD, placebo vs. folate, p < 0.02).

View larger version (15K): [in a new window]   Figure 3 Effect of high-dose folate on coronary dilator reserve. Dilator reserve was measured in normal (WNL) and abnormal (ABNL) regions. Mean data and standard error bars are depicted. Folate increased dilator reserve by 83% in abnormal segments (0.72 ± 0.60 ml/min/g vs. 1.31 ± 1.08 ml/min/g, mean ± SD, placebo vs. folate, p < 0.05), whereas dilator reserve in normal segments remained unchanged (2.00 ± 0.61 ml/min/g vs. 2.12 ± 0.69 ml/min/g, placebo vs. folate, p = NS). Open bars = placebo; solid bars = folate.

View larger version (18K): [in a new window]   Figure 4 Effect of high-dose folate on peak flow ratio. The ratio for peak myocardial blood flow, in abnormal relative to normal segments, is shown for each patient. Group mean data are depicted by the thick line. Folate increased the ratio of flow in abnormal segments relative to normal segments (0.54 ± 0.17 vs. 0.75 ± 0.24, mean ± SD, placebo vs. folate, p < 0.01).