ACTA FAC. MED. NAISS. 2006; 23 (4): 179-184

   Original article

Andreas Rieth, Thorsten Dill, Anja Deetjen, Dragan Djuric, Veselin Mitrovic

Ana Pejcic¹, Snezana Pesevska², Ivana Grigorov³, Marija Bojovic³

Kerckhoff Heart Centre
Departement of Cardiology
Bad Nauheim, Germany

    SUMMARY

    Homocysteine is a physiological product of the human metabolism. It has got primary atherogenic and prothrombotic properties. Moderate hyperhomocysteinemia is widely accepted as a risk factor for venous thromboembolism; its role in atherosclerotic vascular disease is still not well-defined. The objective of this small pilot study was to relate a homocysteine-lowering therapy with folic acid in coronary artery disease patients with mild hyperhomocysteinemia to benefits concerning endothelial function, carotid wall thickness and myocardial perfusion.
    A total of 15 patients with stable coronary artery disease and hyperhomocysteinemia was randomized, of whom 10 were treated with folic acid 5 mg/daily per os over a period of 6 months. Five patients received (single-blinded) placebo. Measurement of endothelial function by determination of the forearm blood flow, measurement of wall thickness of arteria carotis communis by MRI and of myocardial ischemia by adenosin-stress MRI was performed initially and after the treatment period of 6 months.
    Homocysteine levels fell significantly by 34% under therapy with folic acid as expected. Endothelium function improved by 27 % under the treatment, while under placebo, a minor improvement by 3 % was seen. This trend of a positive treatment effect reached no significance however because of a small number of patients. Carotid structure and myocardial perfusion did not show any significant improvement, also.
    In this pilot study, treatment of mild hyperhomocysteinemia in patients with stable coronary artery disease did not improve the vascular status despite lowering homocysteine levels. Maybe only the treatment of severe forms of hyperhomocysteinemia shows a noticeable benefit.

Key words: hyperhomocysteinemia, endothelial dysfunction, coronary artery disease