Vitamin supplementation can markedly reduce the homocysteine elevation induced by fenofibrate.
Elevated homocysteine concentrations are a risk factor for atherosclerotic disease. Recently it was reported that lipid lowering with fibrates increases homocysteine by up to 40%. Since elevated homocysteine concentrations can readily be lowered by vitamin supplementation, a randomized, double-blind crossover study was performed to investigate the effect of fenofibrate plus folic acid, vitamin B6 and B12 versus fenofibrate plus placebo in hyperlipidemic men. The crossover study comprised a run-in period of 6 weeks, a first treatment phase of 6 weeks, a washout phase of 8 weeks and a second treatment phase of 6 weeks. Vitamins were given at doses of 650 microg folic acid, 50 microg vitamin B12 and 5 mg vitamin B6 per day for a period of 6 weeks. After fenofibrate plus placebo the increase in homocysteine concentration was 44+/-47%. After fenofibrate plus vitamins it was 13+/-25%, being significantly lower than without vitamins. The increase in homocysteine in response to fenofibrate may counteract the cardioprotective effect of lipid lowering. The addition of vitamins involved in homocysteine metabolism can prevent most of the homocysteine increase seen after fenofibrate plus placebo. Addition of these vitamins to fenofibrate may therefore be warranted for routine use.
Dierkes
J
J
Institute of Clinical Chemistry and Biochemistry, Leipziger Str. 44, D-39120 Magdeburg, Germany. jutta.dierkes@medizin.uni-magdeburg.de
Westphal
S
S
Kunstmann
S
S
Banditt
P
P
Lössner
A
A
Luley
C
C
D018592:Cross-Over Studies; D004311:Double-Blind Method; D011345:Fenofibrate / Q000009:adverse effects* / Q000627:therapeutic use; D005492:Folic Acid / Q000008:administration & dosage; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood* / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011736:Pyridoxine / Q000008:administration & dosage; D014805:Vitamin B 12 / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage*
D000960:Hypolipidemic Agents; D014815:Vitamins; D006710:Homocysteine; D005492:Folic Acid; D011736:Pyridoxine; D014805:Vitamin B 12; D011345:Fenofibrate