Effect of Homocysteine-Lowering B Vitamin Treatment on Angiographic Progression of Coronary Artery Disease: A Western Norway B Vitamin Intervention Trial (WENBIT) Substudy

被引:38
作者
Loland, Kjetil H. [1 ]
Bleie, Oyvind [2 ]
Blix, Are J. [1 ]
Strand, Elin [1 ]
Ueland, Per M. [1 ]
Refsum, Helga [3 ,4 ]
Ebbing, Marta [1 ]
Nordrehaug, Jan E. [1 ,2 ]
Nygard, Ottar [1 ,2 ]
机构
[1] Univ Bergen, Inst Med, Bergen, Norway
[2] Haukeland Hosp, Dept Heart Dis, N-5021 Bergen, Norway
[3] Univ Oslo, Inst Basic Med Sci, Dept Nutr, Oslo, Norway
[4] Univ Oxford, Dept Physiol Anat & Genet, Oxford, England
关键词
INTRAVASCULAR ULTRASOUND; CARDIOVASCULAR EVENTS; STENT RESTENOSIS; FOLIC-ACID; ATHEROSCLEROSIS; SUPPLEMENTATION; HYPERHOMOCYSTEINEMIA; RISK;
D O I
10.1016/j.amjcard.2010.01.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Total plasma homocysteine (tHcy) is an independent risk factor for coronary artery disease, and tHcy is lowered by B vitamins. To assess the effect of homocysteine-lowering B-vitamin treatment on angiographic progression of coronary artery disease, this substudy of the Western Norway B Vitamin Intervention Trial (WENBIT) included patients who had undergone percutaneous coronary intervention. The patients were randomized to daily oral treatment with folic acid, vitamin B-12, and vitamin B-6 or placebo in a 2 x 2 factorial design. The coronary angiograms obtained at baseline and follow-up were evaluated. The primary angiographic end points were the changes in minimum lumen diameter and diameter stenosis. A total of 348 subjects (288 men) with a mean +/- SD age of 60 +/- 10.2 years were followed up for a median of 10.5 months (twenty-fifth, seventy-fifth percentile 9.2, 11.8). The baseline median plasma tHcy level was 10.0 mu mol/L (twenty-fifth, seventy-fifth percentile 8.1, 11.0), and treatment with folic acid/vitamin B-12 lowered the tHcy levels by 22%. At follow-up, we found 309 lesions with a significant decrease from baseline in the minimum lumen diameter of a mean of -0.16 +/- 0.4 mm and an increase in the diameter stenosis of 4.4 +/- 0.7%. Treatment with folic acid/vitamin B-12 or vitamin B-6 was not associated with a change in diameter stenosis or minimum lumen diameter. In a post hoc analysis, folic acid/vitamin B-12 treatment was significantly associated with rapid progression (odds ratio 1.84, 95% confidence interval 1.07 to 3.18). In conclusion, vitamin B treatment showed no beneficial effect on the angiographic progression of coronary artery disease, and the post hoc analyses suggested that folic acid/vitamin B-12 treatment might promote more rapid progression. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1577-1584)
引用
收藏
页码:1577 / 1584
页数:8
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