文摘
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 B12, and vitamin B6 or placebo in a 2 × 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 μmol/L (twenty-fifth, seventy-fifth percentile 8.1, 11.0), and treatment with folic acid/vitamin B12 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 B12 or vitamin B6 was not associated with a change in diameter stenosis or minimum lumen diameter. In a post hoc analysis, folic acid/vitamin B12 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 B12 treatment might promote more rapid progression.
