Effect of folic acid treatment on carotid intima-media thickness of patients with coronary disease.
BACKGROUND
Carotid intima-media thickness (CIMT) is a surrogate marker of cardiovascular morbility. Hyperhomocysteinemia, which is an independent cardiovascular risk factor, is associated with low folate levels. The aim of this study was to evaluate the effect of folic acid treatment on the evolution of CIMT in patients with coronary disease and homocysteinemia > or =9 micromol/l.


METHODS
In 137 consecutive patients with coronary disease treated with statins and normal vitamin B12 values, a randomized treatment with open-label folic acid 2.5 mg/day (group A) or not (group B) was performed during 3 years. CIMT was evaluated by two-dimensional ultrasonography baseline and at the final of the study.


RESULTS
Clinical, biochemical parameters and CIMT were similar in both groups of patients. Homocysteine levels decreased (12.4+/-3.4 vs. 10.3+/-2.4 micromol/l; p<0.001) in group A, but not in group B. CIMT did not change neither in group A (0.71+/-0.23 vs. 0.69+/-0.20 mm; p=0.34) nor in group B (0.74+/-0.23 vs. 0.72+/-0.29 mm; p=0.39). In 12 patients of group A with methylenetetrahydrofolate reductase (MTHFR) 677TT mutation a decrease of CIMT was found (0.83+/-0.35 vs. 0.72+/-0.27 mm; p=0.02), but a multiple linear regression only showed a trend to the association between CIMT changes and MTHFR 677TT (p=0.051), probably due to the small number of patients with this mutation.


CONCLUSIONS
Long-time treatment with folic acid in patients with coronary disease and normal values of vitamin B12 decreases homocysteine levels. A CIMT decrease is observed in treated patients with MTHFR 677TT mutation.
Fernández-Miranda
Consuelo
C
Hospital Universitario 12 de Octubre, Madrid, Service of Internal Medicine (Lipid and Atherosclerosis Unit), Madrid, Spain. cfmiranda@telefonica.net <cfmiranda@telefonica.net>
Yebra
Miguel
M
Aranda
Jose Luis
JL
Gómez
Pilar
P
Martínez
Joaquín
J
Núñez
Victor
V
Gómez de la Cámara
Agustín
A
D000368:Aged; D000704:Analysis of Variance; D002340:Carotid Artery Diseases / Q000188:drug therapy / Q000517:prevention & control; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006710:Homocysteine / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D018608:Ultrasonography, Doppler
D006710:Homocysteine; D005492:Folic Acid