Decreased Rate of Coronary Restenosis after Lowering of Plasma Homocysteine Levels
Guido Schnyder, M.D., Marco Roffi, M.D., Riccardo Pin, M.D., Yvonne Flammer, M.D., Helmut Lange, M.D., Franz R. Eberli, M.D., Bernhard Meier, M.D., Zoltan G. Turi, M.D., and Otto M. Hess, M.D.
Background We have previously demonstrated an association betweenelevated total plasma homocysteine levels and restenosis afterpercutaneous coronary angioplasty. We designed this study toevaluate the effect of lowering plasma homocysteine levels onrestenosis after coronary angioplasty.
Methods A combination of folic acid (1 mg), vitamin B12 (400µg), and pyridoxine (10 mg) — referred to as folatetreatment — or placebo was administered to 205 patients(mean [±SD] age, 61±11 years) for six months aftersuccessful coronary angioplasty in a prospective, double-blind,randomized trial. The primary end point was restenosis withinsix months as assessed by quantitative coronary angiography.The secondary end point was a composite of major adverse cardiacevents.
Results Base-line characteristics and initial angiographic resultsafter coronary angioplasty were similar in the two study groups.Folate treatment significantly lowered plasma homocysteine levelsfrom 11.1±4.3 to 7.2±2.4 µmol per liter(P<0.001). At follow-up, the minimal luminal diameter wassignificantly larger in the group assigned to folate treatment(1.72±0.76 vs. 1.45±0.88 mm, P=0.02), and thedegree of stenosis was less severe (39.9±20.3 percentvs. 48.2±28.3 percent, P=0.01). The rate of restenosiswas significantly lower in patients assigned to folate treatment(19.6 percent vs. 37.6 percent, P=0.01), as was the need forrevascularization of the target lesion (10.8 percent vs. 22.3percent, P=0.047).
Conclusions Treatment with a combination of folic acid, vitaminB12, and pyridoxine significantly reduces homocysteine levelsand decreases the rate of restenosis and the need for revascularizationof the target lesion after coronary angioplasty. This inexpensivetreatment, which has minimal side effects, should be consideredas adjunctive therapy for patients undergoing coronary angioplasty.
Source Information
From the Division of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland (G.S., M.R., R.P., Y.F., F.R.E., B.M., O.M.H.); the Kardiologische Praxis, Bremen, Germany (H.L.); and the Division of Cardiology, University of California at San Diego Medical Center, San Diego (Z.G.T.).
Address reprint requests to Dr. Schnyder at the University of California at San Diego Medical Center, Cardiology Division, 200 W. Arbor Dr., San Diego, CA 92103-8784, or at g.schnyder{at}lycos.com.
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