title: Increased dietary micronutrients decrease serum homocysteine concentrations in patients at high risk of cardiovascular disease.
abstract: BACKGROUND
  Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-micromol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater.
  
  
  OBJECTIVE
  Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease.
  
  
  METHODS
  This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide >/=100% of the recommended dietary allowances for 23 micronutrients, including folate.
  
  
  RESULTS
  Mean folate intakes at 10 wk were 601 +/- 143 microgram/d with the PMP and 270 +/- 107 microgram/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 +/- 5.8 to 9.3 +/- 4.9 micromol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD.
  
  
  CONCLUSIONS
  The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease.
authors.affiliation: Division of Metabolism, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: A
authors.initials: A
authors.lastname: Chait
authors.forename: M R
authors.initials: MR
authors.lastname: Malinow
authors.forename: D N
authors.initials: DN
authors.lastname: Nevin
authors.forename: C D
authors.initials: CD
authors.lastname: Morris
authors.forename: R L
authors.initials: RL
authors.lastname: Eastgard
authors.forename: P
authors.initials: P
authors.lastname: Kris-Etherton
authors.forename: F X
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: S
authors.initials: S
authors.lastname: Oparil
authors.forename: L M
authors.initials: LM
authors.lastname: Resnick
authors.forename: J S
authors.initials: JS
authors.lastname: Stern
authors.forename: R B
authors.initials: RB
authors.lastname: Haynes
authors.forename: D C
authors.initials: DC
authors.lastname: Hatton
authors.forename: J A
authors.initials: JA
authors.lastname: Metz
authors.forename: S
authors.initials: S
authors.lastname: Clark
authors.forename: M
authors.initials: M
authors.lastname: McMahon
authors.forename: S
authors.initials: S
authors.lastname: Holcomb
authors.forename: M E
authors.initials: ME
authors.lastname: Reusser
authors.forename: G W
authors.initials: GW
authors.lastname: Snyder
authors.forename: D A
authors.initials: DA
authors.lastname: McCarron
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004032:Diet; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D005527:Food, Fortified; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011736:Pyridoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D006710:Homocysteine; D005492:Folic Acid; D011736:Pyridoxine; D014805:Vitamin B 12