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Homocysteine Lowering and Restenosis After Coronary Angioplasty

Plasma homocysteine levels are associated with vascular disease in various populations. A Swiss team recently observed that restenosis after coronary angioplasty was more likely in patients with high homocysteine levels. In this study, the team posed the next logical question: Does an intervention to lower plasma homocysteine reduce the rate of restenosis?

A total of 205 patients who underwent successful coronary angioplasty were randomized to receive either homocysteine-lowering therapy (1 mg folic acid, 400 µg vitamin B₁₂, and 10 mg pyridoxine) or placebo. At 6 months, patients in the active-treatment group were significantly less likely than placebo recipients to have angiographic restenosis (20 percent vs. 38 percent) or to have undergone revascularization of the target lesion (11 percent vs. 22 percent). Mean plasma homocysteine levels (11 µmol/L in both groups at baseline) were significantly lower in the active-treatment group than in the placebo group at 6 months (7 vs. 9 µmol/L). Patients with the lowest homocysteine levels at follow-up showed the least reduction in luminal diameter on repeat angiography.

Comment: This safe and inexpensive intervention was associated with substantially improved outcomes among patients who underwent coronary angioplasty. Although the benefit presumably was mediated by changes in homocysteine, it remains possible that folate, B₁₂, and pyridoxine have other salutary effects.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 4, 2001

Citation(s):

Schnyder G et al. Decreased rate of coronary restenosis after lowering of plasma homocysteine levels. N Engl J Med 2001 Nov 29 345 1593-1600.

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