Vitamin supplementation can markedly reduce the homocysteine elevation induced by fenofibrate

Elevated homocysteine concentrations are a risk factor for atherosclerotic disease. Recently it was reported that lipid lowering with fibrates increas es homocysteine by up to 40%. Since elevated homocysteine concentrations ca n readily be lowered by vitamin supplementation, a randomized, double-blind crossover study was performed to investigate the effect of fenofibrate plu s folic acid, vitamin B6 and B12 versus fenofibrate plus placebo in hyperli pidemic men. The crossover study comprised a run-in period of 6 weeks, a fi rst treatment phase of 6 weeks, a washout phase of 8 weeks and a second tre atment phase of () weeks. Vitamins were given at doses of 650 mug folic aci d, 50 mug vitamin B12 and 5 mg vitamin B6 per day for a period of 6 weeks. After fenofibrate plus placebo the increase in homocysteine concentration w as 44 +/- 47%. After fenofibrate plus vitamins it was 13 +/- 25%, being sig nificantly lower than without vitamins. The increase in homocysteine in res ponse to fenofibrate may counteract the cardioprotective effect of lipid lo wering. The addition of vitamins involved in homocysteine metabolism can pr event most of the homocysteine increase seen after fenofibrate plus placebo . Addition of these vitamins to fenofibrate may therefore be warranted for routine use. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.