COMBINED VITAMIN-B-6 PLUS FOLIC-ACID THERAPY IN YOUNG-PATIENTS WITH ARTERIOSCLEROSIS AND HYPERHOMOCYSTEINEMIA

Purpose: Hyperhomocysteinemia is associated with arteriosclerotic and thromboembolic events. The homocysteine-lowering effect of combined tr eatment with vitamin B-6 plus folic acid has never been explored in a large group of patients with vascular disease. Therefore we studied th e effects of at least 6 weeks treatment with these vitamins in 72 pati ents with cardiovascular disease and mild hyperhomocysteinemia (define d as an increase of the plasma homocysteine level after methionine loa ding greater than 97.5 percentile of age-matched control subjects but less than 200 mu mol/L). Methods: The existence of mild hyperhomocyste inemia was investigated in 309 consecutive patients under 50 years of age with peripheral arterial occlusive disease, cerebral arterial occl usive disease, or coronary artery occlusive disease. All patients with an abnormal loading test result were treated with vitamin B-6, 250 mg daily, plus folic acid, 5 mg daily. After 6 weeks of treatment a seco nd methionine loading test was performed to assess the homocysteine-lo wering effect. Results: Mild hyperhomocysteinemia was detected in 72 p atients (23%), 33 (46%) of whom also had hyperhomocysteinemia when fas ting. Treatment with vitamin B-6 plus folic acid normalized the postlo ad plasma homocysteine concentration in 66 of the 72 patients (92%), w hereas fasting hyperhomocysteinemia was normalized in 30 of 33 (91%) p atients. in six patients therapy failed to achieve normalization of th e postload homocysteine levels. in three of these patients, the same t reatment was continued for an additional 6 weeks, and in the remaining three patients betaine was added to the treatment regimen. After 6 we eks of additional treatment all six patients had normal postload plasm a homocysteine concentrations. Conclusions: The prevalence of mild hyp erhomocysteinemia in young patients with arterial occlusive disease is high. Simple and inexpensive therapy with vitamin B-6 plus folic acid will normalize homocysteine metabolism, as assessed by the homocystei ne plasma level after methionine loading, in virtually all these patie nts.