Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on cerebrovascular atherosclerosis and white matter abnormalities as determined by MRA and MRI: a placebo-controlled, randomized trial

Background  A high plasma homocysteine concentration is an independent risk factor for large and possibly small vessel disease. We investigated the effects of homocysteine‐lowering treatment with folic acid plus vitamin B6 on markers of cerebrovascular atherosclerosis and cerebral microangiopathy. M...

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Published in:European journal of clinical investigation 2004-04, Vol.34 (4), p.256-261
Main Authors: Vermeulen, E. G. J., Stehouwer, C. D. A., Valk, J., Van Der Knaap, M., Van Den Berg, M., Twisk, J. W. R., Prevoo, W., Rauwerda, J. A.
Format: Article
Language:English
Subjects:
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cerebral atherosclerosis
folic acid
General aspects
homocysteine
Medical sciences
MRI
Vitamin B6
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Summary:Background  A high plasma homocysteine concentration is an independent risk factor for large and possibly small vessel disease. We investigated the effects of homocysteine‐lowering treatment with folic acid plus vitamin B6 on markers of cerebrovascular atherosclerosis and cerebral microangiopathy. Materials and Methods  Using 158 healthy siblings (mean age 46·0 ± 7·6 years) of patients with premature atherosclerotic disease, we performed a randomized, placebo‐controlled trial using 5 mg of folic acid plus 250 mg of vitamin B6 daily (n = 78) or placebo medication (n = 80). Participants were followed for 2 years with magnetic resonance angiography (MRA) (carotid stenosis; carotid and/or vertebral elongation) and magnetic resonance imaging (MRI) (white matter abnormalities; cerebral atrophy). Results  Seventeen (10·8%) subjects refused MRA/MRI owing to claustrophobia and were excluded. From the remaining 141 participants, 68 received vitamin and 73 received placebo medication [42 (61·8%) and 48 (65·8%) had postmethionine hyperhomocysteinaemia, respectively]. Twenty‐four participants (15·2%; 10 in the treatment and 14 in the placebo group) did not complete both years of the trial. Vitamin treatment was associated with an increase in plasma folate (13‐fold vs. placebo; P 
ISSN:0014-2972
1365-2362
DOI:10.1111/j.1365-2362.2004.01332.x