High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial.
High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial.
复制标题
DOI：
10.1161/strokeaha.108.526798
复制
发表时间：
2009-03
期刊：
影响因子：
8.3
通讯作者：
BVAIT Research Group
中科院分区：
文献类型：
--
作者：
Hodis HN;Mack WJ;Dustin L;Mahrer PR;Azen SP;Detrano R;Selhub J;Alaupovic P;Liu CR;Liu CH;Hwang J;Wilcox AG;Selzer RH;BVAIT Research Group
虽然血浆总同型半胱氨酸(THcy)水平与心血管疾病(CVD)有关，但目前尚不清楚同型半胱氨酸是动脉粥样硬化性血管疾病的原因还是标志。我们确定了补充维生素B降低tHcy水平是否可以减少亚临床动脉粥样硬化的进展。在这项双盲临床试验中，506名初始tHcy>；8.5μ/L，无糖尿病和心血管疾病的40-年龄的受试者被随机分为大剂量维生素B补充组(叶酸5 mg+维生素B12 0.4 mg+维生素B6 50 mg)或与之匹配的安慰剂，为期3.1年。使用高分辨率B型超声测量颈动脉内膜-中层厚度(主要结果)和多层螺旋CT测量主动脉和冠状动脉钙化(次要结果)来评估3个血管床的亚临床动脉粥样硬化进展。虽然补充维生素B的患者颈动脉内膜-中层厚度进展率低于服用安慰剂的患者，但组间差异无统计学意义(p=0.31)。然而，在基线tHcy≥9.1Mol/L的受试者中，随机服用维生素B的受试者颈动脉内膜-中层厚度进展的平均比率比安慰剂组显著降低(p=0.02)；在基线tHcy<；9.1Mol/μ/L的受试者中，没有显著的治疗效果(治疗交互作用的p值=0.02)。补充B族维生素对整体或亚组内的主动脉或冠状动脉钙化进展没有影响。大剂量补充维生素B显著减少早期亚临床动脉粥样硬化(颈动脉内膜中层厚度)的进展，在营养良好的健康B族维生素“充足”的低风险患心血管疾病的个体中，空腹tHcy和GT；9.1Mol/L。
Although plasma total homocysteine (tHcy) levels are associated with cardiovascular disease (CVD), it remains unclear whether homocysteine is a cause or a marker of atherosclerotic vascular disease. We determined whether reduction of tHcy levels with B-vitamin supplementation reduces subclinical atherosclerosis progression. In this double-blind clinical trial, 506 participants 40–89 years of age with an initial tHcy >8.5 μmol/L without diabetes and CVD were randomized to high-dose B-vitamin supplementation (folic acid 5 mg + vitamin B12 0.4 mg + vitamin B6 50 mg) or matching placebo for 3.1 years. Subclinical atherosclerosis progression across 3 vascular beds was assessed using high-resolution B-mode ultrasonography to measure carotid artery intima-media thickness (primary outcome) and multidetector spiral computed tomography to measure aortic and coronary artery calcium (secondary outcome). Although the overall carotid artery intima-media thickness progression rate was lower with B-vitamin supplementation than with placebo, statistically significant between-group differences were not found (p=0.31). However, among subjects with baseline tHcy≥9.1 μmol/L, those randomized to B-vitamin supplementation had a statistically significant lower average rate of carotid artery intima-media thickness progression compared with placebo (p=0.02); among subjects with a baseline tHcy <9.1 μmol/L there was no significant treatment effect (p-value for treatment interaction=0.02). B-vitamin supplementation had no effect on progression of aortic or coronary artery calcification overall or within subgroups. High-dose B-vitamin supplementation significantly reduces progression of early stage subclinical atherosclerosis (carotid artery intima-media thickness) in well-nourished healthy B-vitamin “replete” individuals at low-risk for CVD with a fasting tHcy >9.1 μmol/L.