Folic acid-based intervention in non-ST elevation acute coronary syndromes.
Homocysteinemia is a risk factor for cardiovascular diseases. Folic acid combined with vitamins B(6) and B(12) is effective in lowering homocysteine levels. This randomized placebo-controlled study was designed to determine the effect of a folic acid-based supplement on secondary prevention of clinical events in non-ST-segment elevation acute coronary syndromes. The study comprised 240 patients with either unstable angina or non-ST-elevation myocardial infarction in the previous 2 weeks who were randomized to a folate group (n =116) or a placebo group (n =124). The folate group received 1 mg folic acid, 400 microg vitamin B(12), and 10 mg vitamin B(6) daily. Clinical outcomes within 6 months were assessed. The composite endpoint of death, nonfatal acute coronary syndrome, and serious re-hospitalization was significantly higher in the folate group; serious re-hospitalization alone was significantly higher in this group. Advanced age and diabetes increased susceptibility to the composite outcome. Folic acid-based supplementation is not beneficial and may even be harmful in the secondary prevention of cardiovascular events in patients with unstable angina and non-ST-elevation myocardial infarction. Further studies on the safety of such supplements are suggested. Controlled Clinical Trials Registry no. ISRCTN30249553.
Imasa
Marcelo Severino B
MS
Department of Pharmacology, University of the Philippines College of Medicine, Manila.
Gomez
Neil T
NT
Nevado
Jose B
JB
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020138:Hyperhomocysteinemia / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy; D014803:Vitamin B Complex / Q000008:administration & dosage* / Q000009:adverse effects
D014803:Vitamin B Complex; D005492:Folic Acid