Oral folate reduces plasma homocyst(e)ine levels in hemodialysis patients with cardiovascular disease

Introduction: Hyperhomocyst(e)inemia (plasma homocyst(e)ine concentration > 16.0 mu mol/l) is an independent risk factor for atherosclerosis, and is u biquitous in patients with end-stage renal disease (ESRD), Oral folate supp lementation in the non-ESRD population has been demonstrated to reduce plas ma homocyst(e)ine (Hcy) concentration, and may reduce atherosclerotic morbi dity. This study was undertaken to evaluate the efficacy of folate suppleme ntation in reducing Hey in patients with ESRD and cardiovascular disease, Methods: Twenty-eight chronic hemodialysis patients with demonstrated hyper homocyst(e)inemia (mean Hey 35.2 +/- 13.3 mu mol/l) were enrolled in the st udy. The presence of atherosclerosis was documented by history, physical ex amination, or ultrasonographic criteria. Hey was determined initially and f ollowing six weeks' supplementation with 5.0 mg folate and multivitamins, Results: Hey Fell a mean of 15.0 +/- 10.4 mu mol/l (38.9 +/- 19.9%) followi ng supplementation (p < 0.0005, paired t-test), In patients whose Hcy 'norm alized' (n = 10) Hey fell a mean of 51 +/- 14% compared to a reduction of 3 2 +/- 20% in 18 patients whose Hey remained > 16.0 mu mol/l (p = 0.02), A s ignificant positive correlation was observed between initial Hey and both a bsolute and percent reduction after folate supplementation (r = 0.87, p < 0 .005 and 0.53, p < 0.005, respectively). Seven patients with documented ath erosclerosis were older (68 +/- 8 yr vs 51 +/- 5 yr, p = 0.007) an tended t o have lower initial and final Hey than the 21 patients without atheroscler osis (26.8 +/- 9.9 vs 38.0 +/- 13.3 mu mol/l, p = 0.051 and 16.5 +/- 5.0 vs 21.3 +/- 6.7, p = 0.06, respectively). The presence of atherosclerosis was not associated with significant alteration in the response to folate, Conclusions: Supplementation with high-dose folate significantly reduces pl asma Hey in patients with and without atherosclerosis, and the presence of atherosclerosis does not impact on patients' response to folate and multivi tamin supplementation. Hey remained > 16.0 mu mol/l in the majority of pati ents, however. despite large absolute reductions in Hey. Doses of folate gr eater than 5 mg, or additional therapy may be required to further reduce He y in the majority of ESRD patients. (C) 2000 The International Society for Cardiovascular Surgery, Published by Elsevier Science Ltd. All rights reser ved.