Reduction of homocysteine level decreases risk for major adverse events after angioplasty

Angioplasty patients can reduce their subsequent risk of death, myocardial infarction, and need for repeat procedure by taking the homocysteine-reduction combination of folic acid and vitamins B12 and B6, according to an article in the August 28th issue of The Journal of the American Medical Association (JAMA).

Guido Schnyder, M.D., and his American colleagues conducted a randomized, double-blind, placebo-controlled trial with 553 patients who had successful angioplasty involving at least one coronary artery stenosis of 50 percent or more. Their hypothesis was that use of vitamin therapy resulting in decreased plasma homocysteine level could affect outcome after percutaneous coronary intervention.

Participants were randomized to a combination of folic acid (1 mg/d), vitamin B12 (cyanocobalamin, 400 ag/d), and vitamin B6 (pyridoxine hydrochloride, 10 mg/d) (n = 272) or placebo (n = 281) for six months.

According to background information in the article, plasma homocysteine level is recognized as an important predictor of adverse cardiac events in patients with established coronary atherosclerosis and is thought to be a contributor to restenosis after percutaneous coronary intervention.

The researchers found: "After a mean follow-up of 11 months, the composite end point was significantly lower at 1 year in patients treated with homocysteine-lowering therapy [15.4 percent vs. 22.8 percent; 32 percent lower risk, primarily due to a reduced rate of target lesion revascularization (9.9 percent vs. 16.0 percent)]." These findings remained unchanged after adjustment for potential confounders.

"This study provides evidence that homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 improves outcome after percutaneous coronary intervention by reducing the need for repeat revascularization and decreasing the overall incidence of major adverse events one year after successful coronary angioplasty," the authors write.

 

 






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