High-dose folic acid acutely improves coronary vasodilator function in patients with coronary artery disease.
High-dose folic acid acutely improves coronary vasodilator function in patients with coronary artery disease.
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DOI：
10.1016/j.jacc.2005.02.038
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发表时间：
2005-05
影响因子：
24
通讯作者：
A. Tawakol;R. Migrino;K. Aziz;Justyna Waitkowska;G. Holmvang;N. Alpert;J. Muller;A. Fischman;H. Gewirtz
中科院分区：
文献类型：
--
作者：
A. Tawakol;R. Migrino;K. Aziz;Justyna Waitkowska;G. Holmvang;N. Alpert;J. Muller;A. Fischman;H. Gewirtz
ObjectivesWe investigated the acute effect of oral administration high-dose folic acid on coronary diffraction function in humans.BackgroundFolic acid及其活性代谢产物5-methyltetrahydrofolate可增加人外周循环内皮依赖性血管舒张功能。然而，对冠状动脉循环的急性影响是未知的。MethodsFourteen缺血性心脏病患者，年龄62 ± 12岁（平均值± SD），参加了一项双盲，安慰剂对照的交叉试验。用正电子发射断层扫描测定基础和腺苷刺激的心肌血流量（MBF），计算心肌血流储备。每例患者在摄入安慰剂和摄入30 mg叶酸后进行研究。根据MBF对腺苷140 μg/kg/min的反应，将心肌区在生理学上前瞻性地定义为“正常”与“异常”（正常= MBF >1.65 ml/min/g）。在以患者为基础的analysis.ResultsFolate与平均动脉压的降低相关（100 ± 12 mm Hg vs. 96 ± 11 mm Hg，安慰剂vs. Folate，p < 0.03）。尽管平均动脉压下降，叶酸显著增加了异常区MBF对腺苷的剂量反应（方差分析p < 0.001），而正常区MBF没有变化。在异常节段中，叶酸使峰值MBF增加49%（1.45 ± 0.59 ml/min/g vs.2.16 ± 1.01 ml/min/g，p < 0.02）。此外，叶酸可使异常节段的扩张储备增加83（0.77 ± 0.59 vs. ml/min/g 1.41 ± 1.08 ml/min/g，安慰剂vs.叶酸，p < 0.05），而正常节段的扩张器储备保持不变（2.00 ± 0.61 ml/min/g vs.2.12 ± 0.69 ml/min/g，安慰剂vs. folate，p = NS）.结论数据表明，高剂量口服叶酸能显著降低冠心病患者的血压，并增强冠状动脉扩张。
ObjectivesWe investigated the acute effect of orally administered high-dose folic acid on coronary dilator function in humans.BackgroundFolic acid and its active metabolite, 5-methyltetrahydrofolate, increase endothelium-dependent vasodilation in human peripheral circulation. However, the acute effect on coronary circulation is not known.MethodsFourteen patients with ischemic heart disease, age 62 ± 12 years (mean ± SD), were enrolled in a double-blind, placebo-controlled crossover trial. Basal and adenosine-stimulated myocardial blood flow (MBF) were determined by positron emission tomography, and myocardial flow reserve was calculated. Each patient was studied after ingestion of placebo and after ingestion of 30 mg folic acid. Myocardial zones were prospectively defined physiologically as “normal” versus “abnormal” on the basis of MBF response to adenosine 140 μg/kg/min (normal = MBF >1.65 ml/min/g). Abnormal and normal zones were analyzed separately in a patient-based analysis.ResultsFolate was associated with a reduction in mean arterial pressure (100 ± 12 mm Hg vs. 96 ± 11 mm Hg, placebo vs. folate, p < 0.03). Despite the fall in mean arterial pressure, folic acid significantly increased the MBF dose response to adenosine (p < 0.001 using analysis of variance) in abnormal zones, whereas MBF in normal zones did not change. In abnormal segments, folic acid increased peak MBF by 49% (1.45 ± 0.59 ml/min/g vs. 2.16 ± 1.01 ml/min/g, p < 0.02). Furthermore, folate increased dilator reserve by 83% in abnormal segments (0.77 ± 0.59 vs. ml/min/g 1.41 ± 1.08 ml/min/g, placebo vs. folate, p < 0.05), whereas dilator reserve in normal segments remained unchanged (2.00 ± 0.61 ml/min/g vs. 2.12 ± 0.69 ml/min/g, placebo vs. folate, p = NS).ConclusionsThe data demonstrate that high-dose oral folate acutely lowers blood pressure and enhances coronary dilation in patients with coronary artery disease.