The effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis

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dc.contributor.authorPotter, K.
dc.contributor.authorHankey, G.
dc.contributor.authorGreen, D.
dc.contributor.authorEikelboom, J.
dc.contributor.authorJamrozik, K.
dc.contributor.authorArnolda, L.
dc.date.issued2008
dc.description.abstractBackground: Experimental and epidemiological evidence suggests that homocysteine (tHcy) may be a causal risk factor for atherosclerosis. B-vitamin supplements reduce tHcy and improve endothelial function in short term trials, but the long-term effects of the treatment on vascular structure and function are unknown. Methods: We conducted a sub-study of VITATOPS, a randomised, double-blind, placebo-controlled intervention trial designed to test the efficacy of long term B-vitamin supplementation (folic acid 2 mg, vitamin B6 25 mg and vitamin B12 0.5 mg) in the prevention of vascular events in patients with a history of stroke. We measured carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) at least two years after randomisation in 162 VITATOPS participants. We also conducted a systematic review and meta-analysis of studies designed to test the effect of B-vitamin treatment on CIMT and FMD. Results: After a mean treatment period of 3.9 ± 0.9 years, the vitamin-treated group had a significantly lower mean plasma homocysteine concentration than the placebo-treated group (7.9 μmol/L, 95% CI 7.5 to 8.4 versus 11.8 μmol/L, 95% CI 10.9 to 12.8, p < 0.001). Post-treatment CIMT (0.84 ± 0.17 mm vitamins versus 0.83 ± 0.18 mm placebo, p = 0.74) and FMD (median of 4.0%, IQR 0.9 to 7.2 vitamins versus 3.0%, IQR 0.6 to 6.6 placebo, p = 0.48) did not differ significantly between groups. A meta-analysis of published randomised data, including those from the current study, suggested that B-vitamin supplements should reduce CIMT (-0.10 mm, 95% CI -0.20 to -0.01 mm) and increase FMD (1.4%, 95% CI 0.7 to 2.1%). However, the improvement in endothelial function associated with homocysteine-lowering treatment was significant in short-term studies but not in longer trials. Conclusion: Although short-term treatment with B-vitamins is associated with increased FMD, long-term homocysteine-lowering did not significantly improve FMD or CIMT in people with a history of stroke.
dc.description.statementofresponsibilityKathleen Potter, Graeme J Hankey, Daniel J Green, John Eikelboom, Konrad Jamrozik and Leonard F Arnolda
dc.identifier.citationBMC Cardiovascular Disorders, 2008; 8(24):1-14
dc.identifier.doi10.1186/1471-2261-8-24
dc.identifier.issn1471-2261
dc.identifier.issn1471-2261
dc.identifier.urihttp://hdl.handle.net/2440/53974
dc.language.isoen
dc.publisherBioMed Central Ltd.
dc.source.urihttps://doi.org/10.1186/1471-2261-8-24
dc.subjectTunica Media
dc.subjectCarotid Arteries
dc.subjectTunica Intima
dc.subjectHumans
dc.subjectVitamin B 12
dc.subjectFolic Acid
dc.subjectVitamin B Complex
dc.subjectVitamin B 6
dc.subjectHomocysteine
dc.subjectDrug Combinations
dc.subjectTreatment Outcome
dc.subjectDouble-Blind Method
dc.subjectDown-Regulation
dc.subjectRegional Blood Flow
dc.subjectVasodilation
dc.subjectTime Factors
dc.subjectDietary Supplements
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectStroke
dc.titleThe effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished

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