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Therapy with Folate and Vitamins B₁₂ and B₆ After Coronary Angioplasty

Patients who received 6 months of homocysteine-lowering therapy had lower rates of restenosis at 1 year than did placebo recipients.

Results from a recently published Swiss study showed that homocysteine-lowering therapy reduced the 6-month incidence of restenosis in patients who underwent coronary angioplasty (Journal Watch Dec 4 2001). Now, the same investigators report results that include more patients and longer follow-up.

A total of 553 patients underwent percutaneous coronary angioplasty; about half the lesions also were stented. Patients then were randomized to receive 6-month daily courses of homocysteine-lowering therapy (1 mg folic acid, 400 µg vitamin B₁₂, and 10 mg vitamin B₆) or placebo. At 1 year, a composite endpoint (including revascularization, myocardial infarction, and death) occurred significantly less often with active treatment than with placebo (15% vs. 23%). The benefit was attributable largely to a lower rate of repeat revascularization of initial target lesions in the active-treatment group (10% vs. 16%).

Comment: A 6-month course of this inexpensive intervention appears to provide protection against restenosis for at least a year after coronary angioplasty. The presumed mechanism is the homocysteine-lowering effect of the folate/B₁₂/B₆ combination: Plasma homocysteine levels dropped by about 30% in patients who received active treatment. In ongoing studies, investigators are examining whether longer-term treatment with folate and vitamins B₆ and B₁₂ will confer additional benefits in patients with coronary disease.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 6, 2002

Citation(s):

Schnyder G et al. Effect of homocysteine-lowering therapy with folic acid, vitamin B₁₂, and vitamin B₆ on clinical outcome after percutaneous coronary intervention. The Swiss Heart Study: A randomized controlled trial. JAMA 2002 Aug 28; 288:973-9.

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