The effect of different treatment regimens in reducing fasting and postmethionine-load homocysteine concentrations.
OBJECTIVE
To determine the homocysteine-lowering effect of different treatment regimens on both fasting and postmethionine-load plasma total homocysteine (tHcy) concentrations.


METHODS
Descriptive study of consecutive hyperhomocysteinaemic subjects per treatment regimen. Homocysteine was measured in the fasting state and 6 h after methionine loading, both before and after 8 weeks of vitamin therapy. Hyperhomocysteinaemia was defined as a fasting tHcy and/or increase in tHcy (postmethionine-load minus fasting tHcy concentration) exceeding the 95th percentile of local controls.


METHODS
Outpatient clinic of internal medicine of a large non-academic teaching hospital.


METHODS
One hundred and seventeen hyperhomocysteinaemic subjects (vascular patients and first-degree relatives).


METHODS
There were four regimens: pyridoxine, 200 mg; folic acid, 5 mg; combination of folic acid 0.5 mg and pyridoxine 100 mg; and folic acid, 0.5 mg daily.


RESULTS
All regimens, except pyridoxine 200 mg, significantly reduced fasting tHcy without differences in the percentage reduction (32-38%). All regimens produced a significant reduction in the increase in tHcy and postmethionine-load tHcy. The reduction in postmethionine-load tHcy was smaller for pyridoxine 200 mg than for combination therapy. No differences were found in the percentage reduction (for both increase in tHcy and postmethionine-load tHcy) between folic acid 5 mg and folic acid 0.5 mg.


CONCLUSIONS
Monotherapy folic acid (0.5 mg daily) is the lowest effective therapy for reducing both fasting and postmethionine-load tHcy concentrations, with the same results as high-dose folic acid (5 mg daily). Pyridoxine has no additional value.
van der Griend
R
R
Departments of Internal Medicine and Clinical Chemistry, Sint Antonius Hospital, Nieuwegei, The Netherlands.
Biesma
D H
DH
Haas
F J
FJ
Faber
J A
JA
Duran
M
M
Meuwissen
O J
OJ
Banga
J D
JD
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002851:Chromatography, High Pressure Liquid; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011736:Pyridoxine / Q000008:administration & dosage*; D012307:Risk Factors
D006710:Homocysteine; D005492:Folic Acid; D011736:Pyridoxine