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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