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Type: Journal article
Title: Homocysteine-lowering treatment with folic acid, cobalamin, and pyridoxine does not reduce blood markers of inflammation, endothelial dysfunction, or hypercoagulability in patients with previous transient ischemic attack or stroke: A randomized substudy of the VITATOPS trial
Author: Dusitanond, P.
Eikelboom, J.
Hankey, G.
Thom, J.
Gilmore, G.
Loh, K.
Yi, Q.
Klijn, C.
Langton, P.
van Bockxmeer, F.
Baker, R.
Jamrozik, K.
Citation: Stroke, 2005; 36(1):144-146
Publisher: Lippincott Williams & Wilkins
Issue Date: 2005
ISSN: 0039-2499
Statement of
P. Dusitanond, J.W. Eikelboom, G.J. Hankey, J. Thom, G. Gilmore, K. Loh, Q. Yi, C.J.M. Klijn, P. Langton, F.M. van Bockxmeer, R. Baker and K. Jamrozik
Abstract: Background and Purpose— Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine (total homocysteine [tHcy]) accelerate cardiovascular disease by promoting vascular inflammation, endothelial dysfunction, and hypercoagulability. Methods— We conducted a randomized controlled trial in 285 patients with recent transient ischemic attack or stroke to examine the effect of lowering tHcy with folic acid 2 mg, vitamin B12 0.5 mg, and vitamin B6 25 mg compared with placebo on laboratory markers of vascular inflammation, endothelial dysfunction, and hypercoagulability. Results— At 6 months after randomization, there was no significant difference in blood concentrations of markers of vascular inflammation (high-sensitivity C-reactive protein [P=0.32]; soluble CD40L [P=0.33]; IL-6 [P=0.77]), endothelial dysfunction (vascular cell adhesion molecule-1 [P=0.27]; intercellular adhesion molecule-1 [P=0.08]; von Willebrand factor [P=0.92]), and hypercoagulability (P-selectin [P=0.33]; prothrombin fragment 1 and 2 [P=0.81]; D-dimer [P=0.88]) among patients assigned vitamin therapy compared with placebo despite a 3.7-µmol/L (95% CI, 2.7 to 4.7) reduction in total homocysteine (tHcy). Conclusions— Lowering tHcy by 3.7 µmol/L with folic acid-based multivitamin therapy does not significantly reduce blood concentrations of the biomarkers of inflammation, endothelial dysfunction, or hypercoagulability measured in our study. The possible explanations for our findings are: (1) these biomarkers are not sensitive to the effects of lowering tHcy (eg, multiple risk factor interventions may be required); (2) elevated tHcy causes cardiovascular disease by mechanisms other than the biomarkers measured; or (3) elevated tHcy is a noncausal marker of increased vascular risk.
Description: Published online before print November 29, 2004
Rights: © 2005 American Heart Association, Inc.
RMID: 0020081495
DOI: 10.1161/01.STR.0000150494.91762.70
Published version:;36/1/144
Appears in Collections:Public Health publications

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