title: Effect of long-term homocysteine reduction with B vitamins on arterial wall inflammation assessed by fluorodeoxyglucose positron emission tomography: a randomised double-blind, placebo-controlled trial.
abstract: BACKGROUND
  Homocysteine may promote atherosclerosis by exacerbating inflammatory processes within the arterial wall. B-vitamin supplements reduce total plasma homocysteine concentrations (tHcy), but it is not known whether the treatment also reduces arterial wall inflammation. We used (18)F-fluorodeoxygluose positron emission tomography ((18)F-FDG PET) to investigate whether long-term homocysteine-lowering treatment alters arterial wall inflammation in patients with a history of ischemic stroke.
  
  
  METHODS
  30 stroke patients were randomly assigned to B-vitamin therapy (folic acid 2 mg, vitamin B(6) 25 mg and vitamin B(12) 0.5 mg) or placebo in a double-blind clinical trial. After a mean treatment period of 4.0 +/- 0.7 years, all subjects had tHcy, carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) of the brachial artery measured and underwent an (18)F-FDG PET scan. Standardised uptake values (SUV) were measured at six sites in the carotid, femoral and aortic arteries. Areas of locally increased tracer uptake in the arterial wall ('hot spots') were also identified and counted.
  
  
  RESULTS
  Long-term B-vitamin treatment significantly reduced tHcy compared with placebo (8.4 micromol/l, 95% confidence interval, CI, 7.2-9.6 vs. 11.6 micromol/l, 95% CI 10.0-13.4, p = 0.002). The treatment did not affect mean arterial SUV (2.0 +/- 0.3 vitamins vs. 2.1 +/- 0.3 placebo, p = 0.65) or the number of hot spots (n = 1.1 +/- 1.0 vitamins vs. n = 1.2 +/- 1.0 placebo, p = 0.65). There was no significant correlation between mean arterial SUV and CIMT or FMD.
  
  
  CONCLUSIONS
  These results suggest that a long-term Hcy reduction with B vitamins does not affect arterial wall inflammation assessed by (18)F-FDG PET.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, W.A., Australia. pottek04@cyllene.uwa.edu.au
authors.forename: Kathleen
authors.initials: K
authors.lastname: Potter
authors.forename: Nat
authors.initials: N
authors.lastname: Lenzo
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: Leonard F
authors.initials: LF
authors.lastname: Arnolda
authors.forename: Christopher
authors.initials: C
authors.lastname: Beer
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001167:Arteritis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D001916:Brachial Artery / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D019788:Fluorodeoxyglucose F18; D005492:Folic Acid / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation; D014805:Vitamin B 12 / Q000627:therapeutic use; D025101:Vitamin B 6 / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; D019275:Radiopharmaceuticals; D006710:Homocysteine; D019788:Fluorodeoxyglucose F18; D014803:Vitamin B Complex; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12