Prevalence of mild fasting hyperhomocysteinemia in renal transplant versuscoronary artery disease patients after fortification of cereal grain flourwith folic acid

Cereal grain flour products fortified with 140 mu g folic acid per 100 g fl our became widely available in southeast New England by July 1997. We hypot hesized that improved folate status secondary to this fortification policy would have a much more limited impact on the prevalence of mild fasting hyp erhomocysteinemia in renal transplant versus coronary artery disease patien ts. Between October 1997 and October 1998, fasting plasma total homocystein e (tHcy), folate and vitamin B12 levels were determined in a total of 86 re nal transplant patients with stable allograft function, and 175 coronary ar tery disease patients whose serum creatinine was (1.4 mg/dl). All subjects lived in the Providense, RI, metropolitan area, and were either non-users o f any supplements containing folic acid, vitamins B6 or B12, or had refrain ed from using such supplements far greater than or equal to 6 weeks. Geomet ric mean fasting tHcy levels were 88.0% higher (15.6 vs. 8.3 mu mol/l; P < 0.001), and the prevalence of fasting tHcy levels greater than or equal to 12 mu M (69.8% vs. 10.9%, P < 0.001) was markedly increased in the renal tr ansplant patients, despite a much younger mean age and a relative preponder ance of women. In the era of folic acid fortified flour, hyperhomocysteinem ia is much more common in stable renal transplant versus coronary artery di sease patients. As a result, renal transplant patients are a preferable hig h risk target population for controlled trials evaluating the tenable hypot hesis that lowering total homocysteine levels will reduce cardiovascular di sease outcomes. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.