Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis:: a randomised, placebo-controlled trial
Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis:: a randomised, placebo-controlled trial
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DOI：
10.1016/s0140-6736(99)07391-2
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发表时间：
2000-02-12
期刊：
影响因子：
168.9
通讯作者：
Rauwerda, JA
中科院分区：
文献类型：
--
作者：
Vermeulen, EGJ;Stehouwer, CDA;Rauwerda, JA
背景血浆同型半胱氨酸浓度升高与动脉粥样硬化血栓形成疾病的风险增加有关。我们研究了降低同型半胱氨酸治疗（叶酸加维生素B-6）对过早动脉粥样硬化血栓形成疾病患者的健康兄弟姐妹中亚临床动脉粥样硬化标志物的影响。方法我们在167名过早动脉粥样硬化血栓形成疾病患者的158名健康兄弟姐妹中进行了一项随机、安慰剂对照试验。80人被分配安慰剂，78人被分配每天5毫克叶酸和250毫克维生素B-6，为期2年。主要终点是亚临床动脉粥样硬化的发展或进展，根据运动心电图，踝肱压力指数，颈动脉和股动脉超声检查，结果治疗组10名参与者和安慰剂组14名退出。与安慰剂相比，维生素治疗与空腹同型半胱氨酸浓度（从14.7至7.4 μ mol/L vs从14.7至12.0 μ mol/L）和蛋氨酸后同型半胱氨酸浓度（从64.9至34.9 μ mol/L vs从64.8至50.3 μ mol/L）降低相关。它还与运动心电图检查异常率降低相关（比值比0.40 [0.17-0.93]; p=0.035）。维生素治疗对踝臂压力指数无明显影响（0.87 [0.56-1.33]），或颈动脉和外周动脉结局变量（1.02 [0.26-4.05]和0.86 [0.47-1.59]，解释同型半胱氨酸-在患有过早动脉粥样硬化血栓形成疾病的患者的健康同胞中减少叶酸加维生素Be的治疗与异常运动心电图试验的发生率降低有关，这与动脉粥样硬化性冠状动脉事件的风险降低相一致。
Background A high plasma homocysteine concentration is associated with increased risk of atherothrombotic disease. We investigated the effects of homocysteine-lowering treatment (folic acid plus vitamin B-6) on markers of subclinical atherosclerosis among healthy siblings of patients with premature atherothrombotic disease.Methods We did a randomised, placebo-controlled trial among 158 healthy siblings of 167 patients with premature atherothrombotic disease. 80 were assigned placebo and 78 were assigned 5 mg folic acid and 250 mg vitamin B-6 daily for 2 years. The primary endpoint was the development or progression of subclinical atherosclerosis as estimated from exercise electrocardiography, the ankle-brachial pressure index, and carotid and femoral ultrasonography,Findings Ten participants in the treatment group, and 14 in the placebo group dropped out. Vitamin treatment, compared with placebo,was associated with a decrease in fasting homocysteine concentration (from 14.7 to 7.4 mu mol/L vs from 14.7 to 12.0 mu mol/L), and in postmethionine homocysteine concentration (from 64.9 to 34.9 mu mol/L vs from 64.8 to 50.3 mu mol/L). It was also associated with a decreased rate of abnormal exercise electrocardiography tests (odds ratio 0.40 [0.17-0.93]; p=0.035). There was no apparent effect of vitamin treatment on ankle-brachial pressure indices (0.87 [0.56-1.33]), or on carotid and peripheral-arterial outcome variables (1.02 [0.26-4.05] and 0.86 [0.47-1.59], respectively).Interpretation Homocysteine-lowering treatment with folic acid plus vitamin Be in healthy siblings of patients with premature atherothrombotic disease is associated with a decreased occurrence of abnormal exercise electrocardiography tests, which is consistent with a decreased risk of atherosclerotic coronary events.